title: Mechanical circulatory support as a bridge to transplant candidacy.
abstract: BACKGROUND
  The use of mechanical circulatory support (MCS) in nontransplant eligible candidates remains controversial. Our decision to offer MCS for nontransplant candidates has led to their reevaluation after a period of left ventricular assist device (LVAD) support.
  
  
  METHODS
  From 2001 to September 2009, we had 37 patients who received an implantable LVAD, 22 (59%) were not deemed to be transplant eligible at the time of LVAD insertion (bridge to candidacy, BTC group).
  
  
  RESULTS
  Fifteen (41%) patients were considered transplant eligible (bridge to transplant, BTT group) at the time of device insertion and received a HeartMate XVE (n = 7), HeartMate 2 (n = 7), or a Novacor LVAS (n = 1). In the BTC group, patients received the HeartMate XVE device (n = 11), HeartMate 2 (n = 5), or the Novacor LVAS (n = 6). The primary criterion for transplant ineligibility was refractory pulmonary hypertension (PH) in 18 patients, 3 patients did not meet our body mass index criteria (>35 kg/m(2)), and 2 patients were dialysis-dependent. Six (27%) BTC patients died on support. Overall, 16/22 patients (73%) were subsequently listed for transplantation, with one listed for combined heart-lung due to refractory PH. Twelve patients (75%) underwent successful heart transplantation. Three patients died during their transplant. Overall posttransplant survival at one year shows lower survival in the BTC group compared to the BTT group (67% vs. 100%, p = 0.05). At two years and three years the survival was lower, but not statistically different (BTC vs. BTT: 67% vs. 90% and 64% vs. 87%, respectively, p = NS).
  
  
  CONCLUSIONS
  MCS can successfully convert a large proportion of transplant-ineligible patients into acceptable candidates.
authors: Heart Transplant Program, Peter Munk Cardiac Center, Toronto General Hospital, University Health Network, University of Toronto, Ontario, Canada.
authors: Abdelsalam M
authors: AM
authors: Elhenawy
authors: Khaled D
authors: KD
authors: Algarni
authors: Marnie
authors: M
authors: Rodger
authors: Jane
authors: J
authors: Maciver
authors: Manjula
authors: M
authors: Maganti
authors: Robert J
authors: RJ
authors: Cusimano
authors: Terrence M
authors: TM
authors: Yau
authors: Diego H
authors: DH
authors: Delgado
authors: Heather J
authors: HJ
authors: Ross
authors: Vivek
authors: V
authors: Rao
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000401:mortality / Q000628:therapy*; D016027:Heart Transplantation / Q000379:methods* / Q000401:mortality; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D018579:Patient Selection; D011300:Preoperative Care / Q000379:methods*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome