Bridging procedures to heart transplantation

Ventricular assist devices are used to support the failing circulation and consequently bridge patients with end-stage heart disease to heart transplantation. From 1988 through 2000 we mechanically supported 47 patients with a bridge to heart transplantation. Within the same time frame 118 patients were mechanically supported for recovery of the heart. Most presented in acute cardiac failure, and the severe shock leads to high early mortality. Mortality during mechanical support is 36%. During the early experience patients underwent transplantation urgently. With the more recent implantable devices, patients are fully mobilized and given transplants electively. Long-term survival of these patients bridged to transplantation is excellent and does not differ from that for non-bridged patients (5-year survival is 82% for the bridged patients and 84% for the non-bridged patients; p = 0.43). The most frequent device-related problem is excessive bleeding (38%). Thromboembolic phenomena are the most cumbersome complications (11%). The strategy of bridging to heart transplantation has evolved from acute resuscitation and urgent transplantation to medium- and long-term support to optimize the patient's condition. New experience with long-term support and alternative support strategies has created possibilities in the field of "alternatives to heart transplantation."