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CARDIOVASCULAR
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Volume 6, 2001, No 1 |
Long-Term
Results in Patients Undergoing Heart Transplantation While on Mechanical Assist
Device
T. Colombo, G.
Bruschi, S. Agati, C. Marchetti, C. Russo, M. Lanfranconi, M. Frigerio, F.
Oliva, F. Milazzo, M. Visigalli, E. Vitali
Background:
The supply of donor hearts is inadequate to meet the needs of patients with
end-stage heart disease and many severely compromised patients die waiting for a
donor, so different mechanical circulatory support devices have been
investigated as bridge to heart transplant.
International Society for Heart and Lung Transplantation Registry reports
ventricular assist device implant as risk factor for 1 year mortality in adult
heart transplantation.
Methods:
53 patients (mean age 42.5 years, range 16-61) received mechanical circulatory
support as bridge to heart transplant. The causes of heart failure were:
cardiomyopathy in 37 pts, ischemic heart disease in 12 pts, acute myocarditis in
2 pts and acute myocardial infarction in 2 pts.
Results:
38 patients (71.7%) underwent heart transplantation from 1 to 1142 days after
VAD implant, mean support time was 79.3 days, 1 patient (1.8%) is still on VAD.
Hospital survival after HTx was 86.8% (33 /38) (93.5% in LVAD, 57.1% in BVAD); 5
patients died for acute graft failure or multiorgan failure. Actuarial survival
of discharged pts at 1 (96.1±3.7%)
and 5 years (88.1±8.4%)
was similar (p=NS) to patients without pre transplant VAD (97.3±0.8%
and 88.2±1.9)
respectively.
Conclusion:
In our experience early implantation of VADs improved hemodynamics and the
chance of long-term survival as a result of improved end organ function and
physiologic status. Survival rates are comparable in patients with and without
VAD support despite more peroperative critical conditions of VAD patients. It
appears that despite their immunologic impact VAD support does not increase the
incidence of CAV after HTx.
(CVE. 2001; 6 (1): 8-11)
Key words: Mechanical assist device, Heart transplantation, Congestive heart failure
Tiziano
Colombo, M.D.
Department of Cardiac Surgery “A. De Gasperis”
Niguarda Hospital
Piazza Ospedale Maggiore 3
I-20162 Milano
Italy
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