title: Advanced heart failure in critical patients (INTERMACS 1 and 2 levels): ventricular assist devices or emergency transplantation?
abstract: OBJECTIVE
  For patients in advanced heart failure, emergency transplantation or ventricular assist devices (VADs) are possible strategies. The aim of this single-centre, retrospective study was to evaluate early and long-term results for these two strategies.
  
  
  METHODS
  From 2005 to 2011, we analysed 49 INTERMACS level 1 and 2 patients, who were divided into the following two groups: group A comprised 26 patients on the waiting list for heart transplantation with urgent conditions; and group B comprised 23 patients who underwent VAD implantation as a bridge to candidacy.
  
  
  RESULTS
  In group A, 25 patients underwent transplantation. In group B, 19 patients were supported with left VAD and four with biventricular VAD. Of these 23 patients, 13 underwent transplantation (mean time 279 ± 196 days). The 30 day mortality was 42.3 and 4.3% in group A and B, respectively. Survival at 6 and 12 months was significantly better in group B than in group A (87 vs 53%, P = 0.018 at 6 months; and 77 vs 48%, P = 0.045 at 12 months).
  
  
  CONCLUSIONS
  Improved outcomes may justify the use of mechanical assistance devices as a bridge to candidacy or bridge to transplantation in INTERMACS 1 and 2 patients in order to avoid high-risk transplants. Evaluation of long-term multicentre outcomes is needed to assess future strategies.
authors: Division of Cardiac Surgery, San Giovanni Battista Hospital 'Molinette', University of Turin, Turin, Italy. matteoatti@libero.it
authors: Matteo
authors: M
authors: Attisani
authors: Paolo
authors: P
authors: Centofanti
authors: Michele
authors: M
authors: La Torre
authors: Massimo
authors: M
authors: Boffini
authors: Davide
authors: D
authors: Ricci
authors: Marco
authors: M
authors: Ribezzo
authors: Andrea
authors: A
authors: Baronetto
authors: Mauro
authors: M
authors: Rinaldi
mesh_terms: D000328:Adult; D016638:Critical Illness; D004630:Emergencies; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D016027:Heart Transplantation / Q000009:adverse effects / Q000401:mortality; D006353:Heart-Assist Devices / Q000009:adverse effects; D006439:Hemodynamics; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left; D014850:Waiting Lists / Q000401:mortality