Bridging to transplant with the HeartMate left ventricular assist device: The Columbia Presbyterian 12-year experience.
OBJECTIVE
Implantation of a left ventricular assist device as a bridge to transplantation has become an acceptable approach for patients with end-stage heart failure. Our long-term results with 3 Thoratec HeartMate devices are presented to outline improvements in successful bridging to transplantation and post-transplant survival.


METHODS
From August 1990 through January 2003, 243 patients underwent implantation of Thoratec HeartMate devices as a bridge to transplantation. This included 52 (21.4%) pneumatic devices, 17 (7.0%) dual-lead vented electric devices, and 174 (71.6%) single-lead vented electric devices.


RESULTS
Mean age was 49.7 +/- 13.7 years. Mean support time was 78.1 +/- 82.9 days (0-541). Bridging success increased from 63.5% (n = 33) for pneumatic devices to 64.7% (n = 11) for dual-lead vented electric devices and 72.4% (n = 126) for single-lead vented electric devices (P =.005). Posttransplant 1-, 3-, and 5-year actuarial survival increased from 87.5%, 78.1%, and 71.9% in patients with pneumatic devices to 91.5%, 86.9%, and 81.3%, respectively, for patients with single-lead vented electric devices. Device infection and malfunction occurred in 17.7% (n = 43) and 12.8% (n = 31) of patients, respectively.


CONCLUSIONS
Successful bridging to transplantation and posttransplant survival has improved over time. Left ventricular assist devices have become increasingly more effective in bridging patients with end-stage heart failure to transplantation. This is likely due to a combination of better patient selection, improvements in clinical practice, and evolution in device design.
Morgan
Jeffrey A
JA
Department of Surgery, Division of Cardiothoracic Surgery, Columbia University, College of Physicians and Surgeons, New York, NY 10032, USA.
John
Ranjit
R
Rao
Vivek
V
Weinberg
Alan D
AD
Lee
Brian J
BJ
Mazzeo
Pamela A
PA
Flannery
Margaret R
MR
Chen
Jonathan M
JM
Oz
Mehmet C
MC
Naka
Yoshifumi
Y
D020878:Device Removal; D005260:Female; D006333:Heart Failure / Q000601:surgery*; D016027:Heart Transplantation / Q000401:mortality; D006353:Heart-Assist Devices / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D015996:Survival Rate