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What Will Happen to Permanent Left Ventricular Assist Device Recipients? Clues from Long-Term Outcomes of Heterotopic Heart Transplants

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Heart Replacement

Summary

Donor organ shortage and successful experience with left ventricular assist devices as a bridge to transplantation have prompted us to consider a permanent alternative to transplantation. However, we have little information on the long-term follow-up, because the left ventricular assist device has been used as a bridge to transplantation for a period of just over one year. In recipients of a left ventricular assist device, the potential heart-related complications expected include arrhythmia, thromboembolism, valvular heart disease, and progression of ischemic heart disease. Heterotopic heart transplantation (in which the native heart is retained) may be a good model to study long-term pathophysiological processes in the native heart. We analyzed the prevalence of native-heart-related complications in heterotopic heart transplantation to help in predicting the performance of the native heart in patients with a permanent left ventricular assist device. Between December 1984 and December 1994, 16 patients (13 men, 3 women, 37–60 years old) underwent heterotopic heart transplantation at the University of Pittsburgh. The indication for heterotopic heart transplantation in all recipients was pulmonary hypertension unresponsive to vasodilators. The one- and five-year survival rates after transplantation were 81% and 44%. Pulmonary hemodynamics improved significantly after the operation. The actuarial percentages of patients free of complications related to the native heart after one and four years were, respectively: ventricular arrhythmia: 85%, 75%; ischemic heart disease: 85%, 64%; and valvular heart disease: 100%, 88%. The actuarial freedom from all these complications was 70% after one year and 50% after four years. These results will give us an indication of the native heart performance to expect in the patient with a permanent left ventricular assist device.

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Authors and Affiliations

  1. Department of Surgery, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA

    Osamu Tagusari, Akihiko Kawai, Kenji Yamazaki, Masayuki Miyagishima, Si M. Pham, Brack G. Hattler, Bartley P. Griffith & Robert L. Kormos

  2. Department of Cardiology, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213, USA

    Srinivas Murali

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  1. Osamu Tagusari
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  2. Akihiko Kawai
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  3. Kenji Yamazaki
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  4. Masayuki Miyagishima
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  5. Si M. Pham
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  6. Brack G. Hattler
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  7. Srinivas Murali
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  8. Bartley P. Griffith
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  9. Robert L. Kormos
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Editors and Affiliations

  1. Shonan Center, Terumo Corporation, 1500 Inokuchi, Nakai-machi, Ashigarakami-gun, Kanagawa, 259-01, Japan

    Tetsuzo Akutsu M.D., Ph.D. (Chairman) (Chairman)

  2. Department of Cardiovascular Surgery, The Heart Institute of Japan, Tokyo Women’s Medical College, 8-1 Kawada-cho, Shinjuku-ku, Tokyo 162, Japan

    Hitoshi Koyanagi M.D. (Chairman and Professor) (Chairman and Professor)

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© 1998 Springer-Verlag Tokyo

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Tagusari, O. et al. (1998). What Will Happen to Permanent Left Ventricular Assist Device Recipients? Clues from Long-Term Outcomes of Heterotopic Heart Transplants. In: Akutsu, T., Koyanagi, H. (eds) Heart Replacement. Springer, Tokyo. https://doi.org/10.1007/978-4-431-65921-1_14

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  • DOI: https://doi.org/10.1007/978-4-431-65921-1_14

  • Publisher Name: Springer, Tokyo

  • Print ISBN: 978-4-431-65923-5

  • Online ISBN: 978-4-431-65921-1

  • eBook Packages: Springer Book Archive

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