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Ventricular assist device as a bridge to heart transplantation in adults.

Abstract：

BACKGROUND:Because of the shortage of donor hearts, various ventricular asist devices (VAD) have been used in decompensated patients to prolong patient survival until a suitable heart becomes available. In this paper, we present our single-center report of adult patients in whom bridging was used with VAD. METHODS:We performed a retrospective review of 14 adult patients who underwent heart transplantation after insertion of a long-term VAD. The study spans from February 2006 until September 2010. The mean patient age was 44.28 ± 11.06 years. We used the Berlin Heart EXCOR VADs (n = 11; Berlin Heart AG Berlin, Germany), or the Berlin Heart Incor (n = 2), or the Abiomed AB500 (n = 1). Preimplantation status of the subjects were critical cardiogenic shock (n = 6), deterioration on inotropes (n = 3), or stable but inotrope-dependent (n = 5). RESULTS:Mean VAD support time was 153.71 days (range, 25-517). Major adverse events during VAD support included reexploration for bleeding (n = 3; 21.4%), neurologic events (n = 2; 14.3%), left VAD-related infection (n = 2; 14.3%), pneumonia (n = 1; 14.3%), or primary device failure (n = 1; 7.1%). One (7.1%) patient showed evidence of human leukocyte antigen sensitization. There were 2 deaths (14.3%) over a mean of 324 days follow-up after heart transplantation: One due to biventricular failure in the early postoperative period and the other, at 69 days from pneumonia. Rejection was observed in 2 patients who had International Society for Heart and Lung Transplantation grade 2R without hemodynamic deterioration. In our series, the 1-year mortality was 14.4% among heart transplantations without VAD implantation and 14.2% among the bridge-to-transplantation group. CONCLUSION:We conclude that VAD implantation improved end-organ function before heart transplantation in critically ill patients.

journal_name

Transplant Proc

journal_title

Transplantation proceedings

authors

Engin C,Ayik F,Oguz E,Eygi B,Yagdi T,Karakula S,Ozbaran M

doi

10.1016/j.transproceed.2011.01.147

subject

Has Abstract

pub_date

2011-04-01 00:00:00

pages

927-30

issue

3

eissn

0041-1345

issn

1873-2623

pii

S0041-1345(11)00231-4

journal_volume

43

pub_type

杂志文章

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