Development of a Hub-and-Spoke Durable Left Ventricular Assist Device Program in Brazil, a Middle-Income Country

Objectives To describe the experience of a left ventricular assist device (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 hub-and-spoke model with a single implanting center. Data was collected retrospectively using hospital records and telephone contact with other centers. Patients that received LVAD implants external to the philanthropic program, either at this or other Brazilian centers, were not included. Results Between January 1st, 2013, and December 31st, 2020, 20 adult patients underwent long-term continuous flow LVAD implantation with decentralization of post-implant 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 INTERMACS profile 3 patients. Two patients had Chagas cardiomyopathy. The overall survival censored for competing risks at 1 year 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 post-implant patient care in regional centers is feasible and safe, enabling optimal allocation of resources in middle-income countries.