Perioperative mechanical circulatory support for transplantation

Area of Science:

• Cardiology
• Transplantation Medicine
• Mechanical Circulatory Support

Background:

• Donor organ shortages and long waiting times increase hemodynamic deterioration risk in heart transplant candidates.
• Mechanical circulatory support (MCS) is increasingly used as a supplement to conventional hemodynamic therapies.
• The Utah Transplantation Affiliated Hospitals (UTAH) Cardiac Transplant Program has extensive experience with MCS before and after heart transplantation.

Purpose of the Study:

• To review the UTAH Cardiac Transplant Program's experience with MCS in heart transplant recipients.
• To evaluate the efficacy of MCS used before and after heart transplantation.
• To identify factors influencing the need for and outcomes of MCS in transplant patients.

Main Methods:

• Retrospective review of 401 heart transplant candidates between March 1985 and October 1990.
• Analysis of hemodynamic support strategies employed before transplantation (conventional therapies, oral enoximone, intravenous inotropes, intraaortic balloon, centrifugal blood pump).
• Assessment of outcomes, including need for post-transplant MCS and survival rates.

Main Results:

• Of 401 candidates, 329 received transplants, 38 died awaiting transplant, and 24 were removed from the list.
• Ten patients (3%) required MCS after transplantation, with a 1-year survival rate of 38%.
• Pre-transplant MCS did not significantly impact post-transplant survival rates; 1-year survival for these patients was 86% versus 88% for all transplant patients.

Conclusions:

• Judicious use of MCS enables heart transplant patients with advanced hemodynamic support needs to achieve survival probabilities similar to those undergoing elective transplantation.
• No single factor predicted the need for post-transplant MCS.
• The UTAH program's experience supports the efficacy of MCS as a bridge to recovery or long-term support in heart transplantation.