Related Experiment Videos
Mechanical circulatory support as a bridge to transplantation
Insights
Mechanical circulatory support as a bridge to heart transplantation offers gratifying long-term results for preterminal patients, despite complex post-transplant recovery. This approach demonstrates the viability of advanced support systems in improving survival rates.
Area of Science:
- Cardiology
- Transplantation Medicine
- Medical Engineering
Background:
- Preterminal cardiac failure necessitates advanced interventions.
- Mechanical circulatory support (MCS) offers a potential bridge to heart transplantation.
- Understanding outcomes after MCS bridging is crucial for patient management.
Purpose of the Study:
- To evaluate the outcomes of heart transplantation following mechanical circulatory support.
- To assess the efficacy and complications associated with MCS as a bridge to transplant.
Main Methods:
- Retrospective analysis of 11 patients undergoing heart transplantation between December 1985 and April 1988.
- Patients received various forms of mechanical circulatory support prior to transplant.
- Data collected on support types, duration, transplant complications, and long-term follow-up.
Main Results:
- Eight patients (73%) survived transplant hospitalization, with 100% survival at 6-34 months post-transplant.
- Complications included rejection episodes, serious infections, and major organ system issues.
- Long-term follow-up showed good functional status (90% in functional class I or II) with minimal rehospitalization.
Conclusions:
- Mechanical circulatory support is an effective bridge to heart transplantation for preterminal patients.
- While post-transplant hospitalization can be prolonged and complicated, long-term outcomes are favorable.
- This strategy significantly improves survival and functional capacity in patients with end-stage heart failure.
Abstract:
From December 1985 through April 1988, 11 patients (three female and eight males), 33.1 +/- 3.9 (+/- SEM) years of age (range, 15 to 50 years), underwent heart transplantation preceded by the use of mechanical circulatory support. The causes of cardiac failure were ischemic (four), viral cardiomyopathy (three), idiopathic cardiomyopathy (two), congenital heart disease (one), and valvular heart disease (one). All patients were preterminal. Mechanical circulatory support consisted of intra-aortic balloon pump (eight), the total artificial heart (seven), biventricular assist (three), and left ventricular assist (two). Seven patients had more than one form of support. The duration of mechanical circulatory support was 12.2 +/- 4.1 days (range, 1 to 44 days). Once listed for transplantation, patients waited for 8.1 +/- 2.4 days for a donor. Seven patients received OKT3 monoclonal antibody as prophylaxis, in addition to triple-drug immunosuppression. There were four rejection episodes and 12 serious infections. In addition, eight patients suffered a major posttransplant complication of a distant organ system: central nervous system (three), renal (two), and respiratory (three). Post transplant hospitalization was 48 +/- 22 days (range, 15 to 248 days). Two patients (18%) died after transplant, one of severe acute rejection (29 days) and one of multisystem failure (248 days). All patients surviving transplant hospitalization are alive 6 to 34 months after the transplant procedure. Eight patients are in functional class I and 1 patient class II. This patient attends school full-time but has a premechanical support system neurologic defect. In follow-up of 163 patient-months except for yearly catheterization, these nine patients required only 5 hospital days. Although the use of the mechanical circulatory support as a bridge to transplantation can result in a prolonged, complicated hospitalization after transplant, the long-term results are gratifying.