title: Experience With a Long-term Pulsatile Ventricular Assist Device as a Bridge to Heart Transplant in Adults.
abstract: OBJECTIVE
  Most long-term ventricular assist devices (VADs) that are currently implanted are intracorporeal continuous-flow devices. Their main limitations include their high cost and inability to provide biventricular support. The aim of this study was to describe the results of using paracorporeal pulsatile-flow VADs as a bridge to transplant (BTT) in adult patients.
  
  
  METHODS
  Retrospective analysis of the characteristics, complications, and outcomes of a single-center case series of consecutive patients treated with the EXCOR VAD as BTT between 2009 and 2015.
  
  
  RESULTS
  During the study period, 25 VADs were implanted, 6 of them biventricular. Ventricular assist devices were indicated directly as a BTT in 12 patients and as a bridge to decision in 13 due to the presence of potentially reversible contraindications or chance of heart function recovery. Twenty patients (80%) were successfully bridged to heart transplant after a median of 112 days (range, 8-239). The main complications included infectious (52% of patients), neurological events (32%, half of them fatal), bleeding (28%), and VAD malfunction requiring component replacement (28%).
  
  
  CONCLUSIONS
  Eighty percent of patients with the EXCOR VAD as BTT achieved the goal after an average of almost 4 months of support. The most frequent complications were infectious, and the most severe were neurological. In our enivonment, the use of these pulsatile-flow VAD as BTT is a feasible strategy that obtains similar outcomes to those of intracorporeal continuous-flow devices.
authors.affiliation: Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain; CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain. Electronic address: mgomezbueno@secardiologia.es.
authors.forename: Manuel
authors.initials: M
authors.lastname: Gómez Bueno
authors.affiliation: Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain; CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Segovia Cubero
authors.affiliation: Servicio de Cirugía Cardiaca, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
authors.forename: Santiago
authors.initials: S
authors.lastname: Serrano Fiz
authors.affiliation: Servicio de Cirugía Cardiaca, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Ugarte Basterrechea
authors.affiliation: Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
authors.forename: Francisco José
authors.initials: FJ
authors.lastname: Hernández Pérez
authors.affiliation: Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
authors.forename: Josebe
authors.initials: J
authors.lastname: Goirigolzarri Artaza
authors.affiliation: Servicio de Cirugía Cardiaca, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
authors.forename: Evaristo
authors.initials: E
authors.lastname: Castedo Mejuto
authors.affiliation: Servicio de Cirugía Cardiaca, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
authors.forename: Raúl
authors.initials: R
authors.lastname: Burgos Lázaro
authors.affiliation: Servicio de Cirugía Cardiaca, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
authors.forename: Carlos
authors.initials: C
authors.lastname: García Montero
authors.affiliation: Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
authors.forename: Vanessa
authors.initials: V
authors.lastname: Moñivas Palomero
authors.affiliation: Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
authors.forename: Susana
authors.initials: S
authors.lastname: Mingo Santos
authors.affiliation: Servicio de Anestesia y Reanimación, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
authors.forename: Ana Isabel
authors.initials: AI
authors.lastname: González Román
authors.affiliation: Servicio de Anestesia y Reanimación, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
authors.forename: José Manuel
authors.initials: JM
authors.lastname: Álvarez Avelló
authors.affiliation: Servicio de Anestesia y Reanimación, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
authors.forename: Mercedes
authors.initials: M
authors.lastname: Vidal Fernández
authors.affiliation: Servicio de Cirugía Cardiaca, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain.
authors.forename: Alberto
authors.initials: A
authors.lastname: Forteza Gil
authors.affiliation: Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain; CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Alonso-Pulpón
mesh_terms: D000328:Adult; D005260:Female; D006333:Heart Failure / Q000628:therapy*; D016027:Heart Transplantation; D006353:Heart-Assist Devices; D006470:Hemorrhage / Q000453:epidemiology; D006801:Humans; D007239:Infections / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D020521:Stroke / Q000453:epidemiology; D013927:Thrombosis / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome
keywords: Dispositivo de asistencia ventricular; Heart failure; Heart transplant; Insuficiencia cardiaca; Trasplante cardiaco; Ventricular assist device