Mechanical bridge to transplantation: when is too early? When is too late?
BACKGROUND
Optimal timing of implantation of a mechanical circulatory support system in the treatment of acute cardiogenic shock is still unsettled. The issue has been addressed in a retrospective analysis of a group of 98 patients in cardiogenic shock refractory to medical therapy who were candidates for cardiac transplantation, admitted from 1987 to 1994.


METHODS
The treatment included reinforced inotropic support by addition of phosphodiesterase inhibitors to sympathomimetic agents. The patients who did not improve were immediately brought to the operating room for mechanical circulatory support system implantation.


RESULTS
The overall survival in the group of 28 patients selected for mechanical bridge is 50%. No predictive factors of death or multiorgan failure while on the device could be identified, suggesting a lack of contraindications to mechanical circulatory support system implantation.


CONCLUSIONS
The high death rate in patients maintained on medical therapy because of initial improvement as they are awaiting transplantation suggests the benefit of a rapid semielective implantation of an intracorporeal device.
Loisance
D Y
DY
Department of Thoracic and Cardiovascular Surgery, Centre National de la Recherche Scientifique, Unité de Recherche Associée 1431, Hospital Henri Mondor, Creteil, France.
Pouillart
F
F
Benvenuti
C
C
Deleuze
P H
PH
Mazzucotelli
J P
JP
Le Besnerais
P
P
Mourtada
A
A
D000328:Adult; D005260:Female; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000209:etiology / Q000401:mortality / Q000628:therapy; D015996:Survival Rate; D013997:Time Factors