BVS5000 support after cardiac transplantation.
OBJECTIVE
This study examines short-term mechanical assist device support for cardiac transplant patients and compares their outcomes with nontransplant patients requiring similar support.


METHODS
Of 350 cardiac transplant patients at our institution, 7 patients required mechanical ventricular assistance with the Abiomed BVS5000 assist device (Abiomed, Inc, Danvers, Mass) after transplant secondary to severe acute rejection with cardiogenic shock (n = 4) or primary graft failure (n = 3). Recovery of ventricular function, survival to discharge, and complications were determined for the transplant group and compared with a second group comprising all other patients supported with the BVS5000 at our institution (n = 15). Additionally, the results of prior series reporting mechanical ventricular support of the failing transplant heart are reviewed.


RESULTS
Demographics and duration of support were similar between the groups. The transplant group had a higher wean rate from device relative to the nontransplant group (100% versus 13%; P < 0.01). Five of 7 in the transplant group achieved survival to discharge (71%), relative to 5 of 15 in the nontransplant group (33%). Complications between the two groups were similar, although the transplant group experienced a higher rate of renal insufficiency (57% versus 13%, P = 0.05).


CONCLUSIONS
Severe acute rejection with cardiogenic shock and primary graft failure are two conditions that may warrant mechanical ventricular support in the cardiac transplant patient. Transplant patients with these conditions have a high rate of ventricular functional recovery, greater than nontransplant patients supported with the same device and for a similar period of time. Although the incidence of renal insufficiency was higher, the majority of transplant patients who were supported with the BVS5000 achieved survival to discharge.
Petrofski
Jason A
JA
Division of Cardiothoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC 27703, USA.
Patel
Vijay S
VS
Russell
Stuart D
SD
Milano
Carmelo A
CA
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D004867:Equipment Design / Q000295:instrumentation; D005260:Female; D006084:Graft Rejection / Q000209:etiology / Q000401:mortality / Q000601:surgery; D016027:Heart Transplantation / Q000295:instrumentation*; D006353:Heart-Assist Devices; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009657:North Carolina; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D012086:Reoperation / Q000295:instrumentation; D012770:Shock, Cardiogenic / Q000209:etiology / Q000401:mortality / Q000601:surgery; D016019:Survival Analysis; D016896:Treatment Outcome