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Influence of different assist devices on survival after orthotopic heart transplantation
G Tenderich1, L Arusoglu, A El-Banayosy
1Heart Center North Rhine-Westphalia, Ruhr-University of Bochum, Bad Oeynhausen, Germany.
Insights
Bridging to heart transplantation improved survival rates by 1995. However, mechanical assist devices significantly lower survival for patients with postcardiotomy syndrome.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Medical Technology
Background:
- In 1995, bridging to heart transplantation had a 1.88 risk factor for one-year mortality.
- One-year and three-year survival rates for bridged patients were below 80% in 1995.
Purpose of the Study:
- To evaluate the impact of mechanical assist devices on survival rates in heart transplant recipients.
- To assess improvements in bridging strategies over time.
Main Methods:
- Analysis of 903 orthotopic heart transplantations performed between March 1989 and December 1998.
- Identification of 142 patients requiring bridging to transplantation.
Main Results:
- One-year survival: 76% (no VAD), 86% (VAD-assisted bridging), 66% (VAD for postcardiotomy syndrome).
- Three-year survival: 73% (no VAD), 80% (VAD-assisted bridging), 55% (VAD for postcardiotomy syndrome).
- Electively bridged patients showed better outcomes than the control group, despite VAD complications.
Conclusions:
- Early and late outcomes for heart transplant recipients improved significantly after 1995.
- Mechanical assist device use in postcardiotomy syndrome is associated with significantly lower survival rates.
- Elective bridging with VADs demonstrates improved early and long-term results compared to non-bridged patients.
Background:
In 1995, a risk factor of 1.88 was indicated for one-year mortality in connection with bridging to heart transplantation. Both one-year and three-year survival rates in patients bridged to transplantation were less than 80%.
Methods:
From 3/89 to 12/98, 903 orthotopic heart transplantations were performed at our center in 888 recipients. Bridging was necessary in 142 patients.
Results:
The one-year survival rate was 76% in pts without VAD, 86% in pts bridged with VAD and 66% in pts with VAD due to postcardiotomy syndrome. The three-year survival rates were 73%, 80% and 55% respectively.
Conclusions:
Early and late results in patients bridged to transplantation remarkably improved over 1995. One-year and long-term survival rates are significantly lower when assist devices are used in patients with postcardiotomy syndrome. Despite a high incidence of assist-related complications, electively bridged patients showed significantly better early and long-term results than the control group.