Improved survival after extended bridge to cardiac transplantation.
In the past, left ventricular assist device (LVAD) support was frequently plagued by complications; thus, bridge to transplantation times were kept short. Increasing evidence suggests that extended bridging provides greater benefit due to improved end-organ perfusion and, thus, generally improved physical condition. To assess whether extended bridging translates into improved long-term survival after transplantation, we reviewed our experience with the HeartMate 1000 IP LVAD (Thermo Cardiosystems, Inc, Woburn, MA). Since January 1988, 19 patients (mean age, 45 +/- 9 years) have undergone extended bridging (mean time, 106 +/- 57 days). Their mean weight was 82 +/- 16 kg, and their mean body surface area was 2.0 +/- 0.2 m2. We define "extended" as the length of support necessary for systemic organ recovery after prolonged heart failure. During support, average pump flow indices ranged from 2.3 to 3.3 L.min-1.m-2, and all patients underwent physical rehabilitation. Between the time of LVAD implantation and explantation, the mean serum creatinine value decreased from 1.63 +/- 0.6 to 1.25 +/- 0.6 mg/dL (p = not significant), and the mean serum total bilirubin value decreased from 2.8 +/- 2.0 to 0.63 +/- 0.11 mg/dL (p < 0.05). All but 1 patient improved from New York Heart Association class IV to class I. Device-related complications were minimal. Twelve control patients ("de facto randomized") who did not receive the LVAD also were evaluated: actuarial survival at 1 year was 0% (p < 0.05); 3 (25%) underwent transplantation and died within 2 months; 9 (75%) died before transplantation.(ABSTRACT TRUNCATED AT 250 WORDS)
Frazier
O H
OH
Department of Cardiovascular Research, Texas Heart Institute/St. Luke's Episcopal Hospital, Houston.
Macris
M P
MP
Myers
T J
TJ
Duncan
J M
JM
Radovancević
B
B
Parnis
S M
SM
Cooley
D A
DA
D000328:Adult; D001794:Blood Pressure / Q000502:physiology; D002302:Cardiac Output / Q000502:physiology; D009202:Cardiomyopathies / Q000503:physiopathology / Q000601:surgery / Q000628:therapy; D004867:Equipment Design; D017707:Erythrocyte Transfusion; D005080:Exercise Test; D005260:Female; D006084:Graft Rejection / Q000209:etiology; D006333:Heart Failure / Q000503:physiopathology / Q000601:surgery / Q000628:therapy; D016027:Heart Transplantation / Q000009:adverse effects; D006353:Heart-Assist Devices / Q000009:adverse effects; D006801:Humans; D007668:Kidney / Q000503:physiopathology; D008099:Liver / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000503:physiopathology / Q000601:surgery / Q000628:therapy; D011300:Preoperative Care; D011669:Pulmonary Wedge Pressure / Q000502:physiology; D012189:Retrospective Studies; D015996:Survival Rate