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CARDIOVASCULAR
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Volume 4, 1999, No 1 |
Mechanical Circulatory Assistance Following
Orthotopic Heart Transplantation - From IABP to Biventricular
Support Systems
N. Reiß, A. El-Banayosy, G. Kleikamp, N. Mirow,
L. Arusoglu, G. Tenderich, K. Minami, R. Körfer
Background: Heart transplantation represents a successful therapeutic tool in end-stage heart failure. Nevertheless a significant early morbidity and mortality caused by acute rejection, primary graft failure and right heart failure remains. In these critical situations implantation of a mechanical circulatory support system is the only option to stabilize haemodynamic conditions until retransplantation or recovery.
Methods: Four different support systems were implanted for partial or complete circulatory assistance in patients with post-transplant heart failure.
Results: From March 1989 to March 1997 820 heart transplant procedures were performed at our institution. In 14 patients (39-67 years, 14 male) a mechanical circulatory support system was implanted because of acute rejection (n=6), primary graft failure (n=2), acute right heart failure (n=4) and postoperative low-output-syndrome (n=2). Three patients initially were supported by the Biomedicus centrifugal pump as femoro-femoral bypass and were treated further with the Thoratec device. Four patients were supported by the Biomedicus pump as ventricular assist device, two patients by the Abiomed system, three patients by the Thoratec device and two patients by IABP. The support time ranges from 10 to 273 hours. Three of seven weaned patients died in further course. One patient underwent retransplantation, six patients died whilst on a support system because of multiorgan failure.
Conclusion: The implantation of mechanical circulatory support systems is useful in patients with right heart failure and postoperative low-output-syndrome. In cases of acute rejection and primary graft failure results are not encouraging.
Key words: heart transplantation, acute rejection, primary graft failure, right heart failure, mechanical circulatory support
Address for Correspondence:
N. Reiß, M.D.
Clinic for Thoracic and Cardiovascular Surgery
Heart Center North Rhine-Westphalia
Ruhr University of Bochum
Georgstr. 11
D-32545 Bad Oeynhausen
Germany
Reference:
(CVE. 1999; 4 (1): 23-26)
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