title: Mechanical circulatory support and heart transplantation. Pre-operative status and outcome.
abstract: Between July 1988 and December 1993, 118 patients waiting for heart transplantation underwent mechanical circulatory support by an extracorporeal, pneumatically driven assist device (the Berlin Heart System) to maintain a sufficient circulation and to restore impaired organ function (109 patients requiring a biventricular assist device [BVAD], 9 patients requiring a left ventricular assist device [LVAD]). Before implantation, all patients were in severe cardiogenic shock, despite maximum inotropic support; all had end organ failure. The aim of a retrospective study in 70 patients (for whom pre-operative parameters were available) was to identify patients who would permit from this procedure and could undergo successful transplantation. After a mean bridging time of 34.8 days, 75 (63.5%) patients underwent transplant, and 52 (44.1%) were discharged. Pre-operative coagulation parameters (fibrinogen, antithrombin III, platelet count, and kinetics) were correlated to post-operative blood loss and outcome. Patients who had no or mild coagulation disorders because of a shorter phase of low cardiac output before implantation of the assist device proved to gain faster restitution of organ function and most underwent transplantation. As a result of these observations, implantation of an assist device before shock-induced coagulopathy could occur allowed a greater number of patients to undergo successful bridging and be discharged after heart transplantation.
authors.affiliation: Klinik für Herz, Thorax- und Gefässchirurgie, Deutsches Herzzentrum Berlin, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Schiessler
authors.forename: N
authors.initials: N
authors.lastname: Friedel
authors.forename: Y
authors.initials: Y
authors.lastname: Weng
authors.forename: U
authors.initials: U
authors.lastname: Heinz
authors.forename: M
authors.initials: M
authors.lastname: Hummel
authors.forename: R
authors.initials: R
authors.lastname: Hetzer
mesh_terms: D000293:Adolescent; D000328:Adult; D001698:Biomedical Engineering; D001777:Blood Coagulation; D016063:Blood Loss, Surgical; D002648:Child; D005260:Female; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D011379:Prognosis; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000097:blood / Q000601:surgery / Q000628:therapy; D013997:Time Factors