Ventricular Assist Device Research and Development in Brazil: A Long and Promising Relationship Between Medicine and Engineering.

Abstract

Heart transplantation (HTx) continues to be the gold standard therapy for advanced heart failure refractory to the conservative treatment. Nonetheless, HTx remains as a limited procedure in face of shortage of donors and poor medical conditions that many potential recipients carry or develop over the natural history of the disease. Because of these factors, several patients get their clinical status worsened at the transplant waiting list, and even though with a prioritization path, many of them deteriorate to an unfavorable scenario to receive a heart[1]. The application of mechanical circulatory support devices aims to maintain alive and stable the patients who develop severe clinical conditions that could disable them from receiving a heart in a short term, serving as a bridge therapeutic strategy (bridge-to-transplantation [BTT])[1]. Historically, artificial pumps were developed to support and provide adequate perfusion for patients with difficult weaning from cardiopulmonary bypass (CPB) after heart operations, becoming useful for giving hemodynamic support to bridge transplant candidates when HTx era started in the 1960s. Briefly, left ventricular assist devices (LVADs) were composed by pulsatile pumps, evolving to implantable continuous-flow axial pumps and posteriorly to continuous-flow centrifugal pumps. Currently, LVADs are an accepted therapy in many countries and commonly applied to a variety of heart diseases that lead to circulatory failure, serving not just for BTT strategy, but for bridgeto-decision, bridge-to-recovery, or for destination therapy[2]. 1Centro de Engenharia em Assistência Circulatória, Instituto Dante Pazzanese de Cardiologia, São Paulo, São Paulo, Brazil. 2Programa de Pós-graduação em Medicina/Tecnologia e Intervenção em Cardiologia, Universidade de São Paulo, São Paulo, São Paulo, Brazil. 3Programa de Pós-graduação em Ciência Animal com Ênfase em Produtos Bioativos, Universidade Paranaense, Umuarama, Paraná, Brazil. 4Clínica Cirúrgica de Grandes Animais, Hospital Veterinário, Universidade Paranaense, Umuarama, Paraná, Brazil. 5Medical Electrical Devices Laboratory, Electronics Engineering Division, Instituto Tecnológico de Aeronáutica, São José dos Campos, São Paulo, Brazil.