Microaxial Flow Pump Support in Patients Awaiting Heart Transplantation in Germany

Background: Microaxial flow pumps (mAFP) are increasingly used to bridge unstable patients listed for heart transplantation. While this approach has become a routine in countries with short waiting times, it is unclear whether mAFPs are useful in a setting with shortage of organ donors and prolonged waiting times such as in Germany.

Methods: A retrospective, multicenter analysis of patients supported with mAFP from October 2019 to November 2022 while waiting for heart transplantation in Germany was conducted.

Results: Sixteen patients received mAFP support while on the heart transplant waiting list. The majority of patients (56.2%) were male and the median age was 53 (22–66) years. Dilated cardiomyopathy was the main etiology of heart failure, followed by ischemic cardiomyopathy, toxic cardiomyopathy, congenital heart failure and cardiac allograft vasculopathy (62.4%, 12.5%, 12.5%, 6.3% and 6.3%, respectively). In 12 (75%) patients, the first device was full-support mAFP. Four patients were initially supported with a partial-support device, three were later upgraded to a full-support mAFP. In addition, four patients received concomitant veno-arterial extracorporeal life support, which could be weaned and explanted under continuation of mAFP support. The median mAFP support duration was 38.5 (2.0–119.0) days. Two device failures necessitated an exchange. Hematoma at the implantation site led to surgical re-exploration in two patients; five patients needed renal replacement therapy. No patients suffered a stroke or thromboembolic complications. Thirteen (81.2%) patients were successfully bridged to heart transplantation. Two patients were switched to a durable left ventricular assist device. One patient died on mAFP support during the waiting time.

Conclusion: The use of mAFPs to support patients awaiting heart transplantation in Germany is feasible and safe. Prolonged support times are not associated with device complications. mAFPs can be used as a bridge to transplantation provided right ventricular function is preserved.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
13 February 2024