title: Ventricular assist device as a bridge to heart transplantation in adults.
abstract: BACKGROUND
  Because of the shortage of donor hearts, various ventricular asist devices (VAD) have been used in decompensated patients to prolong patient survival until a suitable heart becomes available. In this paper, we present our single-center report of adult patients in whom bridging was used with VAD.
  
  
  METHODS
  We performed a retrospective review of 14 adult patients who underwent heart transplantation after insertion of a long-term VAD. The study spans from February 2006 until September 2010. The mean patient age was 44.28 ± 11.06 years. We used the Berlin Heart EXCOR VADs (n = 11; Berlin Heart AG Berlin, Germany), or the Berlin Heart Incor (n = 2), or the Abiomed AB500 (n = 1). Preimplantation status of the subjects were critical cardiogenic shock (n = 6), deterioration on inotropes (n = 3), or stable but inotrope-dependent (n = 5).
  
  
  RESULTS
  Mean VAD support time was 153.71 days (range, 25-517). Major adverse events during VAD support included reexploration for bleeding (n = 3; 21.4%), neurologic events (n = 2; 14.3%), left VAD-related infection (n = 2; 14.3%), pneumonia (n = 1; 14.3%), or primary device failure (n = 1; 7.1%). One (7.1%) patient showed evidence of human leukocyte antigen sensitization. There were 2 deaths (14.3%) over a mean of 324 days follow-up after heart transplantation: One due to biventricular failure in the early postoperative period and the other, at 69 days from pneumonia. Rejection was observed in 2 patients who had International Society for Heart and Lung Transplantation grade 2R without hemodynamic deterioration. In our series, the 1-year mortality was 14.4% among heart transplantations without VAD implantation and 14.2% among the bridge-to-transplantation group.
  
  
  CONCLUSIONS
  We conclude that VAD implantation improved end-organ function before heart transplantation in critically ill patients.
authors.affiliation: Ege University Hospital, Department of Cardiovascular Surgery, Izmir, Turkey.
authors.forename: C
authors.initials: C
authors.lastname: Engin
authors.forename: F
authors.initials: F
authors.lastname: Ayik
authors.forename: E
authors.initials: E
authors.lastname: Oguz
authors.forename: B
authors.initials: B
authors.lastname: Eygi
authors.forename: T
authors.initials: T
authors.lastname: Yagdi
authors.forename: S
authors.initials: S
authors.lastname: Karakula
authors.forename: M
authors.initials: M
authors.lastname: Ozbaran
mesh_terms: D000328:Adult; D005260:Female; D016027:Heart Transplantation; D006352:Heart Ventricles / Q000503:physiopathology*; D006353:Heart-Assist Devices / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies