title: [Ventricular assist devices as bridge to heart transplantation in cardiogenic shock or terminal heart failure--12 years experience at the Sheba Medical Center].
abstract: BACKGROUND
  Patients in cardiogenic shock (CS) or with terminal heart failure (THF) are at imminent risk of death while waiting for heart transplantation (HTx). Implantation of left or bi-ventricular assist device (LVAD/BiVAD) as a bridge to HTx may save many of these doomed patients' lives.
  
  
  METHODS
  Between March 1994 and December 2006, 29 terminally ill patients (age 2.5-65 years, mean 48 years) underwent VADs implantation as bridge to HTx. The HeartMate VE LVAD was used in 18 patients, Thoratec pneumatic BiVAD in 7, Berlin Heart Excor BiVAD in one, and HeartMate II axial flow, Thoratec pneumatic and Biomedicus centrifugal LVADs in one each. Indications for VADs implantation were CS in 16 patients (55%) and intractable THF in 13 pts (45%). Etiologies were ischemic in 20 patients, idiopathic dilated, myocarditis and congenital in 2 patients each, and valvular, post partum and HTx graft vasculopathy in one patient each.
  
  
  RESULTS
  Seventeen patients (59%) survived VADs implantation and underwent HTx or are ongoing. Mean survival on VADs was 72 days (range 1-353 days, total 5.2 patient years). Seven patients (24%) were discharged home while on LVAD support for a mean of 146 days. Nine of the transplanted patients (64%) were discharged home. In 4 LVAD patients the cause of death was RV failure necessitating later implantation of RVAD.
  
  
  CONCLUSIONS
  VADs implantation as bridge to HTx in CS or THF saves many of these doomed patients, sometimes providing quality out-of-hospital life while waiting for HTx. Early recognition of RV failure and liberal use of BiVAD is important.
authors: Heart Transplantation Unit, Department of Cardiothoracic Surgery, Sheba Medical Center, Tel Hashomer affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. jaylavee@netvision.net.il
authors: Jacob
authors: J
authors: Lavee
authors: Yigal
authors: Y
authors: Kassif
authors: Dov
authors: D
authors: Freimark
authors: Yedael
authors: Y
authors: Har Zahav
authors: Vera
authors: V
authors: Koman
authors: Sergey
authors: S
authors: Preisman
authors: Aram
authors: A
authors: Smolinsky
authors: Ehud
authors: E
authors: Raanani
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D004867:Equipment Design; D005260:Female; D006333:Heart Failure / Q000601:surgery*; D016027:Heart Transplantation / Q000379:methods*; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000601:surgery*; D014850:Waiting Lists