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Bridging procedures to heart transplantation.
Bart Meyns1, Paul Sergeant, Paul Herijgers
1Department of Cardiac Surgery, KU Leuven, UZ Gasthuisberg, Herestraat 49, 3000 Leuven, Belgium. bart.meyns@uz.kuleuven.ac.be
World Journal of Surgery
|February 28, 2002
Summary
Ventricular assist devices (VADs) effectively bridge patients to heart transplantation, offering excellent long-term survival comparable to non-bridged patients. While complications like bleeding and thromboembolism occur, VADs have evolved to optimize patient condition for transplantation.
Area of Science:
- Cardiology
- Medical Devices
- Surgical Innovation
Background:
- End-stage heart disease necessitates advanced circulatory support.
- Ventricular assist devices (VADs) serve as a bridge to heart transplantation.
- Mechanical support is also utilized for myocardial recovery.
Purpose of the Study:
- To evaluate the outcomes of patients bridged to heart transplantation using mechanical circulatory support.
- To analyze the evolution of VAD strategy from urgent to elective transplantation.
- To assess the long-term survival and complications associated with VADs.
Main Methods:
- Retrospective analysis of 47 patients bridged to transplantation and 118 patients supported for recovery (1988-2000).
- Comparison of survival rates between bridged and non-bridged heart transplant recipients.
- Documentation of device-related complications, including bleeding and thromboembolism.
Main Results:
- Long-term survival for bridged patients (82% at 5 years) was comparable to non-bridged patients (84%).
- Mortality during mechanical support was 36%, with higher early mortality in acute failure cases.
- Device-related complications included excessive bleeding (38%) and thromboembolic phenomena (11%).
Conclusions:
- Mechanical circulatory support is a viable strategy to optimize patients for heart transplantation.
- The evolution of VADs allows for elective transplantation and improved patient mobilization.
- VADs offer promising alternatives to heart transplantation and enhance long-term patient outcomes.