Bridging for Heart Transplantation by Different Types of Ventricular Assist Device

Summary

From the beginning of our heart transplant program in March 1989 until June 1996, 767 orthotopic heart transplantations (HTx) have been performed. The mean age of the patients was 51 years (range: 3 days to 73 years). Almost half (49.1%) of the patients had dilatative cardiomyopathy (DCM); 39.4% had ishemic heart disease (IHD); 5.9%, valvular disease (VD); 3.4%, congenital heart disease (CHD); and 0.4%, acute myocarditis. In 11 patients, re-HTx was necessary. Corresponding to the international experience with restricted number of donor organs, the average waiting time in our patients increased markedly, from 37.6 days in 1989 to 232.5 days in 1995. A total of 448 patients were given transplants between March 1989 and March 1993 (group 1) and 313 patients between March 1993 and June 1996 (group 2). A mechanical assist device (VAD) was used for bridging to HTx in 33 patients (7.3%) in group 1; the VAD types used were Bio-Medicus (n = 7), Abiomed (n = 11), Thoratec (n = 15), and Novacor (n = 2). In Group 2, 68 patients (21.7%) were bridged by VAD using Thoratec (n = 40), Novacor (n = 15), HeartHate (n = 9), and Medos (n = 1). The early mortality in patients bridged to HTx was 8.7% in group 1 and 5.2% in group 2 (P < 0.01). The actuarial survival rate of the patients who were bridged prior to transplantation was 86% in electively bridged patients and 67% in postcardiotomy patients. We conclude that application of VAD in severely ill patients prior to HTx leads to reduction of the early hospital morbidity and mortality due to improvement of hemodynamic and general physical condition.