Differential indication for mechanical circulatory support following heart transplantation.
OBJECTIVE
We describe our experience with ventricular assist devices (VAD) in patients with cardiogenic shock refractory to pharmacological therapy and support using intraaortic balloon pump after cardiac transplantation.


METHODS
Between July 1987 and August 1997, 848 patients underwent cardiac transplantation in our hospital.


METHODS
Fifteen patients (1.8%) needed mechanical circulatory support for refractory cardiac failure due to right heart failure (six patients), primary graft failure (three patients), and acute rejection (six patients). Three pump systems were used: Biomedicus Centrifugal Pump, Abiomed BVS 500, and Thoratec VAD. The choice of system depended on the indication and quality of each device. Seven patients (47%) could be weaned from the mechanical circulatory support (MCS) system and three patients (20%) are long-term survivors.


RESULTS
All 15 patients developed at least one serious complication, such as multiorgan failure (MOF), liver failure, acute renal failure or sepsis. Twenty-five per cent had severe bleeding and 13% had neurological complication. Mortality was due mostly to MOF, MOF and sepsis or sepsis. The survivors had a CI greater than 2.2 l.min.m2, total bilirubin less than 1.0 U/1, and did not undergo resuscitation.


CONCLUSIONS
Heart failure after cardiac transplantation severe enough to require MCS is currently associated with several major complications and high mortality (80%).
Minev
P A
PA
Department of Thoracic and Cardiovascular Surgery, Heart Center North Rhine-Westphalia, Ruhr University of Bochum, Bad Oeynhausen, Germany.
El-Banayosy
A
A
Minami
K
K
Körtke
H
H
Kizner
L
L
Körfer
R
R
D000328:Adult; D000368:Aged; D002303:Cardiac Output, Low / Q000628:therapy; D002423:Cause of Death; D005260:Female; D005858:Germany / Q000453:epidemiology; D006084:Graft Rejection / Q000628:therapy; D016027:Heart Transplantation / Q000401:mortality; D006353:Heart-Assist Devices; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology / Q000401:mortality; D011183:Postoperative Complications / Q000401:mortality / Q000628:therapy*; D012770:Shock, Cardiogenic / Q000150:complications / Q000401:mortality / Q000628:therapy*; D016019:Survival Analysis; D013997:Time Factors