The incidence of isolated left ventricular failure in bridge-to-transplant candidates

Twenty-one patients (pts) were supported with mechanical devices as a bridge to cardiac transplantation (Tx). Ventricular function was assessed by a combination of angiography, echocardiography, nuclear scans, hemodynamics, and visual inspection at the time of device insertion. Twelve pts had biventricular failure (BVF) and 11 received biventricular support with extracorporeal membrane oxygenation (two pts), biventricular assist devices (VAD) (eight pts), or an artificial heart (one pt). One BVF pt received a left VAD (LVAD) and drug support for severe right ventricular failure (RVF), which resolved after 48 hr. The remaining nine pts had left ventricular failure (LVF), with only mild to moderate RVF, and received LVADs with minimal drugs. Eleven pts were tx, with nine survivors. A comparison of pts with LVF vs BVF revealed no differences in age, gender, device flows, duration of support, diagnosis, number tx, or number survived. The incidence of LVF was 43% vs 57% BVF in bridge-to-transplant pts. LVAD support alone is often successful in pts with mild or moderate BVF, but is rarely successful in pts with severe BVF.