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Bridging to cardiac transplantation
1Department of Cardiovascular Surgery, Pacific Presbyterian Medical Center, San Francisco, California 94115.
Insights
Prosthetic ventricles and artificial hearts offer a 4-year bridge to cardiac transplantation for patients with rapidly deteriorating conditions. Device selection is crucial for successful outcomes in these critical heart failure patients.
Area of Science:
- Cardiovascular Surgery
- Biomedical Engineering
- Transplantation Medicine
Background:
- Prosthetic ventricles and artificial hearts have been utilized for bridging to transplantation for four years.
- Patients requiring a bridge to transplantation often face rapid deterioration or sudden cardiac decompensation, such as massive myocardial infarction with cardiogenic shock.
- Careful patient selection is paramount to ensure suitability for heart transplantation despite their critical condition.
Purpose of the Study:
- To compare the outcomes of various artificial heart devices used for bridging to cardiac transplantation.
- To evaluate the efficacy of different prosthetic ventricles in managing patients with end-stage heart failure awaiting transplantation.
Main Methods:
- Review and comparison of clinical results from available bridging devices.
- Analysis of patient selection criteria for cardiac transplantation in deteriorating candidates.
- Inclusion of devices such as the centrifugal pump, Jarvik-7 orthotopic prosthetic ventricle, and heterotopic prosthetic ventricles (Thoratec, Novacor, Thermedics).
Main Results:
- The study compares the performance of different artificial heart technologies.
- Outcomes are assessed for patients bridging to transplantation using various prosthetic ventricular devices.
- The selection of appropriate candidates who are good transplant recipients despite rapid decline is highlighted.
Conclusions:
- The use of prosthetic ventricles and artificial hearts provides a vital option for bridging to transplantation.
- Effective patient selection is critical for optimizing outcomes in this high-risk population.
- Comparative data on available devices aids in clinical decision-making for artificial heart support.
Abstract:
Unilateral or bilateral prosthetic ventricles and artificial hearts have been used in bridging to transplantation for 4 years. Candidates for bridging to transplantation comprise patients who otherwise would be elective cardiac transplantation candidates who deteriorate rapidly before a donor heart can be found, or persons with sudden cardiac decompensation (eg, massive myocardial infarction with cardiogenic shock). In selecting patients for bridging to cardiac transplantation it is crucial that people are chosen who are good candidates for heart transplantation despite their rapidly deteriorating condition. This article compares the results of the devices available for use in this application, which include: the centrifugal pump; the Jarvik-7 orthotopic prosthetic ventricle; and the Thoratec, Novacor, and Thermedics heterotopic prosthetic ventricles.