title: Cardiac transplantation after bridged therapy with continuous flow left ventricular assist devices.
abstract: BACKGROUND
  Cardiac transplantation is an effective surgical therapy for end-stage heart failure. Patients (pts) may need to be bridged with a continuous flow left ventricular assist device (CF-LVAD) while on the transplant list as logistic factors like organ availability are unknown. Cardiac transplantation post-LVAD can be a surgically challenging procedure and outcome in these pts is perceived to be poorer based on experience with earlier generation pulsatile flow pumps. Data from a single institution comparing these pts with those undergoing direct transplantation in the present era of continuous flow device therapy are limited.
  
  
  OBJECTIVE
  Evaluate results of cardiac transplantation in pts bridged with a CF-LVAD (BTx) and compare outcomes with pts undergoing direct transplantation (Tx) in a single institution.
  
  
  RESULTS
  From June 2007 till January 2012, 106 pts underwent cardiac transplantation. Among these, 37 (35%) pts (51±11 years; 85% male) were bridged with a CF-LVAD (BTx), while 70 (65%) comprised the Tx group (53±12 years; 72% males). The median duration of LVAD support was 227 (153,327) days. During the period of LVAD support, 10/37 (27%) pts were upgraded to status 1A and all were successfully transplanted. Median hospital stay in the BTx (14 days) was slightly longer than the Tx group (12 days) but not statistically significant (p=0.21). In-hospital mortality in the BTx (5%) and Tx (1%) were comparable (p=0.25). Estimated late survival in the BTx cohort was 94±7, 90±10 and 83±16% at the end of one, two and three years, respectively which was comparable to 97±4%, 93±6% and 89±9% for the Tx group (p=0.50).
  
  
  CONCLUSIONS
  Cardiac transplantation after LVAD implant can be performed with excellent results. Patients can be supported on the left ventricular assist device even for periods close to a year with good outcome after cardiac transplantation.
authors: Division of Cardiovascular Surgery, Mayo Clinic, USA.
authors: Salil V
authors: SV
authors: Deo
authors: Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors: Kiick
authors: K
authors: Sung
authors: Division of Cardiovascular Surgery, Mayo Clinic, USA.
authors: Richard C
authors: RC
authors: Daly
authors: Division of Cardiovascular Surgery, Mayo Clinic, USA.
authors: Ishan K
authors: IK
authors: Shah
authors: Division of Cardiovascular Surgery, Mayo Clinic, USA.
authors: Salah E
authors: SE
authors: Altarabsheh
authors: Division of Cardiovascular Surgery, Mayo Clinic, USA.
authors: John M
authors: JM
authors: Stulak
authors: Division of Cardiovascular Surgery, Mayo Clinic, USA.
authors: Lyle D
authors: LD
authors: Joyce
authors: Department of Cardiovascular Diseases, Mayo Clinic, USA.
authors: Barry A
authors: BA
authors: Boilson
authors: Department of Cardiovascular Diseases, Mayo Clinic, USA.
authors: Sudhir S
authors: SS
authors: Kushwaha
authors: Division of Cardiovascular Surgery, Mayo Clinic, USA. Electronic address: park.soon@mayo.edu.
authors: Soon J
authors: SJ
authors: Park
mesh_terms: D000328:Adult; D000368:Aged; D009202:Cardiomyopathies / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D005260:Female; D016027:Heart Transplantation / Q000379:methods*; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors
keywords: Cardiomyopathy; Circulatory assist devices; Heart failure; Surgical therapy; Transplantation (heart)