title: Bridge to transplantation using paracorporeal biventricular assist devices or the syncardia temporary total artificial heart: is there a difference?
abstract: OBJECTIVE
  Biventricular support can be achieved using paracorporeal ventricular assist devices (p-BiVAD) or the Syncardia temporary total artificial heart (t-TAH). The purpose of the present study was to compare survival and morbidity between these devices.
  
  
  METHODS
  Data from 2 French neighboring hospitals were reviewed. Between 1996 and 2009, 148 patients (67 p-BiVADs and 81 t-TAH) underwent primary, planned biventricular support. There were 128 (86%) males aged 44±13 years.
  
  
  RESULTS
  Preoperatively, p-BiVAD recipients had significantly lower systolic and diastolic blood pressures, more severe hepatic cytolysis and higher white blood cell counts than t-TAH recipients. In contrast, t-TAH patients had significantly higher rates of pre-implant ECLS and hemofiltration. Mean support duration was 79±100 days for the p-BiVAD group and 71±92 for t-TAH group (P=0.6). Forty two (63%) p-BiVAD recipients were bridged to transplantation (39, 58%) or recovery (3, 5%), whereas 51 (63%) patients underwent transplantation in the t-TAH group. Death on support was similar between groups (p-BiVAD, 26 (39%); t-TAH, 30 (37%); P=0.87). Survival while on device was not significantly different between patient groups and multivariate analysis showed that only preimplant diastolic blood pressure and alanine amino-transferase levels were significant predictors of death. Post-transplant survival in the p-BiVAD group was 76±7%, 70±8%, and 58±9% at 1, 3, and 5 years after transplantation, respectively, and was similar to that of the t-TAH group (77±6%, 72±6%, and 70±7%, P=0.60).
  
  
  CONCLUSIONS
  Survival while on support and up to 5 years after heart transplantation was not significantly different in patients supported by p-BiVADs or t-TAH. Multivariate analysis revealed that survival while on transplantation was not affected by the type of device implanted.
authors.affiliation: Department of Cardiothoracic Surgery, La Pitié‑Salpêtrière Hospital, Université Pierre et Marie Curie, Paris VI, Groupe Hospitalier Pitié‑Salpêtrière, Paris, France - matthias.kirsch@psl.aphp.fr.
authors.forename: A
authors.initials: A
authors.lastname: Nguyen
authors.forename: M
authors.initials: M
authors.lastname: Pozzi
authors.forename: C
authors.initials: C
authors.lastname: Mastroianni
authors.forename: P
authors.initials: P
authors.lastname: Léger
authors.forename: D
authors.initials: D
authors.lastname: Loisance
authors.forename: A
authors.initials: A
authors.lastname: Pavie
authors.forename: P
authors.initials: P
authors.lastname: Leprince
authors.forename: M
authors.initials: M
authors.lastname: Kirsch
mesh_terms: D000328:Adult; D005260:Female; D005602:France; D006333:Heart Failure / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D016027:Heart Transplantation; D006354:Heart, Artificial; D006353:Heart-Assist Devices; D006439:Hemodynamics; D006784:Hospitals, Teaching; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D020127:Recovery of Function; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right; D014850:Waiting Lists