Development of a hub-and-spoke durable left ventricular assist device program in Brazil, a middle-income country

Development of a hub-and-spoke durable left ventricular assist device program in Brazil, a middle-income country

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Background: In middle-income countries, costs limit widespred use of left ventricular assist device (LVAD) as a strategy for end-stage heart failure.We aim to describe the experience of a LVAD program in a middle-income country in a hub-and-spoke model.Methods: Patients fulfilling strict inclusion and exclusion criteria were referred from different centers in Brazil for LVAD implantation through a philanthropy program financed via a Brazilian Federal Government tax exemption structure.LVAD implantation was performed in a hub-and-spoke model with a single implanting center.Data were collected retrospectively using hospital records and telephone contact with other centers.

Patients who received LVAD implants external to Swim - Mens Suits - Competitive the philanthropic program, either at this or other Brazilian centers, were not included.Results: Between January 1, 2013 and December 31, 2020, 20 adult patients underwent long-term continuous flow LVAD implantation with decentralization of postimplant patient care in regional centers.Patients were referred from 11 centers from 7 states in Brazil and underwent LVAD implantation through a philanthropy program.The median age was 52.5 years and 85% were Interagency Registry for Mechanically Assisted Circulatory Support profile 3 patients.

Two Sofas patients had Chagas cardiomyopathy.The overall survival censored for competing risks at 1 and 2 years were 90% and 84%, respectively.Three patients (15%) underwent heart transplantation in the first 2 years after LVAD implantation.Twelve patients returned to their original centers and were followed remotely.Conclusions: This study presents a successful LVAD implantation program in a hub-and-spoke model in Brazil.

Centralization of LVAD implantation with decentralization of postimplant patient care in regional centers is feasible and safe, enabling optimal allocation of resources in middle-income countries.