title: A single German center experience with intermittent inotropes for patients on the high-urgent heart transplant waiting list.
abstract: OBJECTIVE
  Currently, more than 900 patients with end-stage heart failure are listed for heart transplantation in Germany. All patients on the Eurotransplant high-urgent status (HU) have to be treated in intensive care units and have to be relisted every 8 weeks. Long-term continuous inotropes are associated with tachyphylaxia, arrhythmias and even increased mortality. In this retrospective analysis, we report our single center experience with HU patients treated with intermittent inotropes as a bridging therapy.
  
  
  RESULTS
  117 consecutive adult HU candidates were treated at our intensive care heart failure unit between 2008 and 2013, of whom 14 patients (12 %) were stabilized and delisted during follow-up. In the remaining 103 patients (age 42 ± 15 years), different inotropes (dobutamine, milrinone, adrenaline, noradrenaline, levosimendan) were administered based on the patient's specific characteristics. After initial recompensation, patients were weaned from inotropes as soon as possible. Thereafter, intermittent inotropes (over 3-4 days) were given as a predefined weekly (until 2011) or 8 weekly regimen (from 2011 to 2013). In 57 % of these patients, additional regimen-independent inotropic support was necessary due to hemodynamic instabilities. Fourteen patients (14 %) needed a left- or biventricular assist device; 14 patients (14 %) died while waiting and 87 (84 %) received heart transplants after 87 ± 91 days. Cumulative 3 and 12 months survival of all 103 patients was 75 and 67 %, respectively.
  
  
  CONCLUSIONS
  Intermittent inotropes in HU patients are an adequate strategy as a bridge to transplant; the necessity for assist devices was low. These data provide the basis for a prospective multicenter trial of intermittent inotropes in patients on the HU waiting list.
authors.affiliation: Medizinische Abteilung, Kliniken der Barmherzigen Schwestern, Krankenhaus Neuwittelsbach, Renatastrasse 71a, 80639, Munich, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Hübner
authors.affiliation: Medizinische Abteilung, Kliniken der Barmherzigen Schwestern, Krankenhaus Neuwittelsbach, Renatastrasse 71a, 80639, Munich, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Nickel
authors.affiliation: Zentrum für Kardiologie am Klinikum Starnberg, Starnberg, Germany.
authors.forename: G
authors.initials: G
authors.lastname: Steinbeck
authors.affiliation: Medizinische Klinik und Poliklinik I, Universitätsklinikum Großhadern der Ludwig-Maximilans Universität, Munich, Germany.
authors.forename: S
authors.initials: S
authors.lastname: Massberg
authors.affiliation: Herzchirurgische Klinik, Universitätsklinikum Großhadern der Ludwig-Maximilans Universität, Munich, Germany.
authors.forename: R
authors.initials: R
authors.lastname: Schramm
authors.affiliation: Walter Brendel Center for Experimental Medicine, Munich, Germany.
authors.forename: B
authors.initials: B
authors.lastname: Reichart
authors.affiliation: Herzchirurgische Klinik, Universitätsklinikum Großhadern der Ludwig-Maximilans Universität, Munich, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Hagl
authors.affiliation: Medizinische Abteilung, Kliniken der Barmherzigen Schwestern, Krankenhaus Neuwittelsbach, Renatastrasse 71a, 80639, Munich, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Kiwi
authors.affiliation: Medizinische Abteilung, Kliniken der Barmherzigen Schwestern, Krankenhaus Neuwittelsbach, Renatastrasse 71a, 80639, Munich, Germany. prof.weis@krankenhaus-neuwittelsbach.de.
authors.forename: Michael
authors.initials: M
authors.lastname: Weis
mesh_terms: D000328:Adult; D002316:Cardiotonic Agents / Q000008:administration & dosage*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006333:Heart Failure / Q000401:mortality* / Q000517:prevention & control* / Q000601:surgery; D016027:Heart Transplantation / Q000401:mortality*; D006801:Humans; D008297:Male; D011292:Premedication / Q000401:mortality*; D011300:Preoperative Care / Q000401:mortality; D015995:Prevalence; D012307:Risk Factors; D015996:Survival Rate; D014019:Tissue Donors / Q000600:supply & distribution; D016896:Treatment Outcome; D014850:Waiting Lists / Q000401:mortality*
chemical_list: D002316:Cardiotonic Agents
keywords: Heart failure; Heart transplantation; Inotropic therapy; Intensive care medicine
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