title: Bridging to transplant with the HeartMate left ventricular assist device: The Columbia Presbyterian 12-year experience.
abstract: 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.
authors.affiliation: Department of Surgery, Division of Cardiothoracic Surgery, Columbia University, College of Physicians and Surgeons, New York, NY 10032, USA.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Morgan
authors.forename: Ranjit
authors.initials: R
authors.lastname: John
authors.forename: Vivek
authors.initials: V
authors.lastname: Rao
authors.forename: Alan D
authors.initials: AD
authors.lastname: Weinberg
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Lee
authors.forename: Pamela A
authors.initials: PA
authors.lastname: Mazzeo
authors.forename: Margaret R
authors.initials: MR
authors.lastname: Flannery
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Chen
authors.forename: Mehmet C
authors.initials: MC
authors.lastname: Oz
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Naka
mesh_terms: 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