Résumé
Ventricular assist devices (VADs) are used to bridge the patient with end-stage heart failure to cardiac transplantation (BTT) or to destination therapy (DT).
Since 2003 in the Montpellier’s hospital, 29 VADs have been implanted (8 to DT). In the majority of cases, the VAD was used in acute end-stage of heart failure; one-year mortality was 45%.
Unlike inotropic agents, levosimendan, a new calcium senziter, enhances myocardial contractility without increasing myocardial oxygen consumption.
15 out of 29 patients were on the Intermacs classification level 1, on a scale of 1 to 7, 9 received levosimendan and 6 did not.
9 of 29 patients were undergoing to levosimendan infusion to prevent right ventricular failure; 5 were under mechanical ventilation and 5 under Extra-corporal membran oxygenation (ECMO) or trans-aortic left ventricular discharge by Impella 5.0 (Abiomed) before LVAD. 7 out of 29 patients (77.8%) were alive one year later, among who one died from cancer. 2 patients were under ECMO after LVAD.
In contrast, only 6 patients out of 29 patients (20,7%) without levosimendan are alive after one year.
Multivariate analysis demonstrated a significant independant effect of levosimendan infusion on one year mortality in this retrospective study.