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CPR, ECLS, BVAD and successful heart transplantation within 2 months: a single-centre case series in two young,
Anna K Schmidt1, Diyar Saeed1, Arash Mehdiani1
1Department of Cardiovascular Surgery, Düsseldorf University Clinic, Düsseldorf - Germany.
Insights
Bridging heart transplant candidates with acute decompensation using a left ventricular assist device (LVAD) and temporary right ventricular assist device (RVAD) can improve outcomes. This strategy reduces mortality for patients awaiting heart transplantation.
Area of Science:
- Cardiology
- Transplantation Medicine
- Medical Devices
Background:
- Organ shortage remains a significant challenge for heart transplant candidates.
- Timely escalation of therapy and effective bridging strategies are crucial for improving outcomes.
- Acute decompensation in patients with dilated cardiomyopathy poses a high risk during the waiting period.
Observation:
- Two young patients with dilated cardiomyopathy and acute decompensation were successfully bridged to heart transplantation.
- Both patients received a left ventricular assist device (LVAD) combined with a temporary right ventricular assist device (RVAD).
Findings:
- This combined LVAD and temporary RVAD approach facilitated successful bridging to heart transplantation within two months.
- The temporary nature of the RVAD avoided potential long-term complications associated with a permanent biventricular assist device (BVAD).
Implications:
- This strategy offers a viable option to reduce mortality in heart of the United Network for Organ Sharing (UNOS)-listed patients experiencing acute cardiac deterioration.
- Further clinical studies are warranted to validate the efficacy and long-term benefits of this bridging strategy.
Introduction:
In times of organ shortage, death while on the heart waiting-list still represents a major problem. As a consequence, bridging to transplant as well as the decision when to escalate therapy play a very important role.
Methods And Results:
We report on two young patients with dilated cardiomyopathy and acute decompensation who were successfully bridged to heart transplantation with both left and temporary right ventricular assist devices in just 2 months.
Conclusions:
As a permanent biventricular assist device (BVAD) would have definitely impaired the patients' outcome after HTX, we decided to implant an LVAD with a temporary RVAD. In our opinion, this represents a suitable strategy to reduce mortality in HU-listed patients with acute deterioration of cardiac pump function and should be further evaluated in future studies.
