title: Effect of mechanical circulatory support on outcomes after heart transplantation.
abstract: BACKGROUND
  Mechanical circulatory support (MCS) before heart transplantation was previously associated with worse post-transplant outcomes than when MCS was not required. Given the changes in technology, expertise, patient selection, and timing of subsequent transplantation, we hypothesized that patients who require MCS before heart transplantation have similar outcomes after transplantation as those not requiring pre-transplant MCS.
  
  
  METHODS
  We retrospectively reviewed 278 patients who underwent cardiac transplantation from 1993 to 2002. MCS was required in 72 patients (HeartMate LVAS in 66, CardioWest Total Artificial Heart in 6) and was not required in 206 patients. The influence of pre-transplant MCS on post-transplant outcomes was assessed in the 2 groups.
  
  
  RESULTS
  Baseline clinical characteristics (age, gender, etiology of heart failure, history of diabetes mellitus, and donor age and gender) were similar in the 2 groups. One-month and 1-year survival after transplantation did not differ between the groups (MCS, 92% and 85%, respectively vs no MCS, 97% and 92%, respectively). Similar proportions of patients were free from rejection (International Society for Heart and Lung Transplantation score >or=3A) at 1 year of follow-up (MCS, 56% vs no MCS, 52%, p = 0.60). No difference was observed between MCS and no MCS patients in other post-transplant events such as hospital stay, intensive care unit stay, extubation time, acute allograft dysfunction, reoperation rates, acute renal dysfunction, acute hepatic dysfunction, infections, arrhythmias, thromboembolic complications, neurologic complications, gastrointestinal complications and the development of cardiac allograft vasculopathy. The incidence of chronic renal insufficiency was actually lower in the MCS Group (15.3% vs 37.9%, p = .001).
  
  
  CONCLUSIONS
  Post-transplant outcomes after pre-transplant use of MCS are similar to those when MCS is not required.
authors.affiliation: Utah Transplantation Affiliate Hospitals Cardiac Transplant Program, Salt Lake City, UT, USA.
authors.forename: Stavros G
authors.initials: SG
authors.lastname: Drakos
authors.forename: Abdallah G
authors.initials: AG
authors.lastname: Kfoury
authors.forename: James W
authors.initials: JW
authors.lastname: Long
authors.forename: James C
authors.initials: JC
authors.lastname: Stringham
authors.forename: Edward M
authors.initials: EM
authors.lastname: Gilbert
authors.forename: Stephanie A
authors.initials: SA
authors.lastname: Moore
authors.forename: Beverly K
authors.initials: BK
authors.lastname: Campbell
authors.forename: Karl E
authors.initials: KE
authors.lastname: Nelson
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Horne
authors.forename: Dale G
authors.initials: DG
authors.lastname: Renlund
mesh_terms: D000208:Acute Disease; D000328:Adult; D016022:Case-Control Studies; D002908:Chronic Disease; D005260:Female; D006333:Heart Failure / Q000601:surgery; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome