title: Left ventricular assist devices as bridge to heart transplantation: The Niguarda Experience.
abstract: BACKGROUND
  Congestive heart failure is the leading cause of death in Western countries. Heart transplantation currently is the only accepted therapy for patients with end-stage heart failure, but the supply of donor hearts is inadequate, and different mechanical circulatory support systems have been investigated as bridges to heart transplant.
  
  
  METHODS
  Since April 1992, 53 patients (47 men, 6 women, aged 12 to 61 years) received left ventricle mechanical circulatory support as bridge to heart transplant. The two principal devices used were: the Novacor LVAS in 31 patients and the DeBakey VAD in 11 patients.
  
  
  RESULTS
  All patients survived the operation. Mean duration of LVAD support was 2.8 +/- 5.6 months. Thirty-seven patients (71.1%) underwent heart transplantation. Twelve major bleeding episodes occurred in nine patients (16.9%). Globally, major and minor neurologic events occurred in 13 patients (24.5%). Ten patients (19.9%) assisted with the Novacor Wearable LVAS device were discharged at home while waiting for heart transplant (HTx). The mean follow-up of the 34 discharged transplanted patients was 45.3 +/- 37 months. Actuarial survival of transplanted patients while on LVAD was 91.0 +/- 4.9% and 83.4 +/- 8.5% at 1 and 5 years, respectively. No differences in post-transplant long-term survival and rejection and allograft vasculopathy occurred between patients transplanted with or without LVAD implanted.
  
  
  CONCLUSIONS
  LVAD therapy proved to be effective in bridging patients with end-stage heart failure to HTx. While on LVAD support, patients assisted with implantable wearable devices could be discharged at home, ameliorating their quality of life. The excellent survival rate after HTx is concomitant with a low incidence of rejection and cardiac allograft vasculopathy.
authors.affiliation: Department of Cardiac Surgery, A. De Gasperis, Niguarda Hospital, Milan, Italy. evitali@ospedaleniguarda.it
authors.forename: Ettore
authors.initials: E
authors.lastname: Vitali
authors.forename: Marco
authors.initials: M
authors.lastname: Lanfranconi
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Bruschi
authors.forename: Claudio
authors.initials: C
authors.lastname: Russo
authors.forename: Tiziano
authors.initials: T
authors.lastname: Colombo
authors.forename: Elena
authors.initials: E
authors.lastname: Ribera
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D015331:Cohort Studies; D004869:Equipment Safety; D005260:Female; D006333:Heart Failure / Q000401:mortality* / Q000601:surgery / Q000628:therapy*; D016027:Heart Transplantation / Q000379:methods / Q000401:mortality; D006353:Heart-Assist Devices; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D011336:Probability; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000401:mortality / Q000628:therapy; D014850:Waiting Lists