title: The effect of the sequential therapy in end-stage heart failure (ESHF)--from ECMO, through the use of implantable pump for a pneumatic heart assist system, Religa Heart EXT, as a bridge for orthotopic heart transplant (OHT). Case study.
abstract: BACKGROUND
  Modern Polish medicine offers patients various treatments for end-stage treatment-resistant heart failure. Methods applied at the right time before the occurrence of irreversible changes in organs give a chance for survival and prolong life.
  
  
  METHODS
  Here, we report on the safety and efficacy of the sequential use of the above treatments in a 58-year old patient with heart failure in dilatative cardiomyopathy (DCM). A 7-day mechanical blood circulatory support and extracorporeal membrane oxygenation of blood (ECMO), followed by a 13-day implantation of a left ventricular assist device, Religa Heart EXT, was used as a bridge to a successful orthotopic heart transplant (OHT). On Day 40 after OHT, the patient was discharged home with stable function of the circulatory system. We describe our experiences with the qualification, preparation, and procedure of sequential ECMO, Religa Heart EXT, and OHT.
  
  
  CONCLUSIONS
  Application of short-term ECMO as a bridge-to-bridge helped save the patient from severe cardiogenic shock caused by increased left ventricular afterload. The experimental implantation of an innovative Religa Heart EXT prosthesis was a safe and efficacious bridge to transplantation. Too short time of Religa Heart EXT implantation in the discussed patient prevented the possibility to evaluate the occurrence of thromboembolic complications and infections compared to the documented complications of POLVAD implanted until now. OHT is a safe and efficacious method of treatment of patients previously supported by ECMO and Religa Heart EXT.
authors.affiliation: Department of Cardiac Surgery and Transplantation, Institute of Cardiology, Warsaw, Poland.
authors.forename: Grzegorz
authors.initials: G
authors.lastname: Religa
authors.affiliation: Department of Anaesthesiology, Institute of Cardiology, Warsaw, Poland.
authors.forename: Małgorzata
authors.initials: M
authors.lastname: Jasińska
authors.affiliation: Department of Anaesthesiology, Institute of Cardiology, Warsaw, Poland.
authors.forename: Łukasz
authors.initials: Ł
authors.lastname: Czyżewski
authors.affiliation: Department of Anaesthesiology, Institute of Cardiology, Warsaw, Poland.
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Torba
authors.affiliation: Department of Cardiac Surgery and Transplantation, Institute of Cardiology, Warsaw, Poland.
authors.forename: Jacek
authors.initials: J
authors.lastname: Różański
mesh_terms: D002311:Cardiomyopathy, Dilated / Q000503:physiopathology / Q000601:surgery / Q000628:therapy; D015199:Extracorporeal Membrane Oxygenation / Q000295:instrumentation; D006333:Heart Failure / Q000503:physiopathology / Q000601:surgery* / Q000628:therapy*; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006801:Humans; D008297:Male; D008875:Middle Aged; D011044:Poland; D011474:Prosthesis Design; D012770:Shock, Cardiogenic / Q000517:prevention & control