Circulatory support with a centrifugal pump as a bridge to cardiac transplantation.
Since January 1985, the Heart Transplant Program at Washington University Medical Center, St. Louis, has performed 89 heart transplantations in 86 patients. Twenty patients (23%) have required preoperative mechanical support of circulation or respiration prior to transplantation. The Bio-Medicus centrifugal pump (Bio-Pump) formed the basis of our circulatory support system during the period of this report. Nine patients were placed on the Bio-Pump with the intention of bridging them to transplantation. Six patients required left ventricular assistance; in 2, the device was inserted because they could not be weaned from cardiopulmonary bypass. Two patients required biventricular assistance, 1 because she could not be weaned from cardiopulmonary bypass at the end of a cardiac operation. Extracorporeal membrane oxygenation was necessary in 1 patient for right ventricular decompensation and cardiac arrest four hours after orthotopic cardiac transplantation. One of these 9 patients died on circulatory support, and in another, a complication developed that precluded transplantation. The remaining 7 patients (78%) underwent a successful transplant procedure after an average of 1.6 days of circulatory support (range, 0.5 to three days), and all are long-term survivors of transplantation. There has been 1 late death at 17 months from a cerebrovascular hemorrhage. In summary, the centrifugal pump provides excellent short-term circulatory support for individuals who would otherwise die before cardiac transplantation.
Bolman
R M
RM
Department of Surgery, Washington University School of Medicine, St. Louis, Missouri.
Cox
J L
JL
Marshall
W
W
Kouchoukos
N
N
Spray
T L
TL
Cance
C
C
Genton
R E
RE
Saffitz
J
J
D000293:Adolescent; D000328:Adult; D001243:Assisted Circulation / Q000295:instrumentation*; D006328:Cardiac Catheterization; D002315:Cardiopulmonary Bypass; D015199:Extracorporeal Membrane Oxygenation / Q000295:instrumentation; D005260:Female; D016027:Heart Transplantation; D006352:Heart Ventricles; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications