Permanent ventricular assist device support versus cardiac transplantation.
BACKGROUND
Although cardiac transplantation provides excellent therapy for some patients with terminal heart failure, the results are limited by the scarcity of donor organs, reduced long-term survival, and comorbid conditions. Current experience with temporary left ventricular assist devices suggest that a permanent, totally, or near totally implantable device may be a viable alternative.


METHODS
We analyzed data from the 1997 International Society for Heart and Lung Transplantation (ISHLT) Registry and other literature on heart transplantation and compared survival and complication rates with our experience and that of others with temporary ventricular assist devices. From these data, we attempted to identify those patients who would benefit most from permanent left ventricular assist systems (LVASs).


RESULTS
Among heart transplant candidates, United Network for Organ Sharing (UNOS) status II, O blood type, weight >180 lb, older age, and preformed antibodies are negative factors for receipt of donor hearts. Of patients transplanted, women and nonwhites have poorer outcomes. Success with wearable LVAS's suggest some of these patients might be better served with an LVAS than with cardiac transplantation.


CONCLUSIONS
Because LVAS's could be made readily available without the need for a waiting list, they might compete well with the strategy of cardiac transplantation.
Pennington
D G
DG
Department of Cardiothoracic Surgery, Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157, USA. gpenning@wfubmc.edu
Oaks
T E
TE
Lohmann
D P
DP
D000328:Adult; D000368:Aged; D002423:Cause of Death; D004867:Equipment Design; D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D017052:Hospital Mortality; D006801:Humans; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D012307:Risk Factors; D015996:Survival Rate