Bridging to heart transplantation with circulatory support devices

Several devices are currently available for bridging to cardiac transplantation, but the efficacy of each has not been established. From September 1983 to March 1988 we supported 17 transplant candidates with mechanical assist devices. Extracorporeal membrane oxygenation (ECMO) was used to bridge two patients, external ventricular assist devices (VADs) were used in 11 patients, internal left ventricular assist systems (LVAS) were used in three patients, and implantable prosthetic replacement ventricles (TAH) were used in one patient. The 14 men and three women, aged 24 to 59 years (mean 46 years), suffered cardiogenic shock caused by ischemic (13 patients), postpartum (two patients), viral (one patient), and drug-induced (one patient) cardiomyopathy. Five patients with isolated left ventricular failure (LVF) received only left VADs, three patients with severe LVF and moderate right ventricular failure received LVAS, and nine patients with severe biventricular failure received ECMO (two patients), biventricular assist devices (six patients), and TAH (one patient). Patients were supported for periods of 1/2 to 90 days (mean 22) with flows of 2.15 to 3.39 L/min/m2. Ten patients underwent transplantation (eight of whom were discharged) and seven patients died without transplants. The two patients who received ECMO died 1 and 30 days after transplantation, in part as a result of ECMO complications. Seven patients were denied transplants because of renal failure (five patients), infection (five patients), bleeding (four patients), and cerebrovascular accident (two patients). The seven survivors were supported with VADs (five patients) or LVAS (two patients). Three had driveline infections, two had bleeding complications, two developed mediastinitis, and one each had hemolysis, cerebrovascular accident, and mechanical failure.(ABSTRACT TRUNCATED AT 250 WORDS)