Bridge to heart transplantation: the Penn State experience

At The Pennsylvania State University, we have performed four bridge-to-heart transplantation procedures in the past year. Two patients were supported with an LVAD, and two patients were supported with a TAH. One patient had a successful transplantation and remains well 10 months after operation; two patients died of sepsis after transplantation. A fourth patient has had a TAH in place for greater than 110 days and is currently awaiting transplantation. The problems that remain to be solved are developing strategies to minimize the risk of infection, defining the indications for use of an LVAD vs a BVAD vs a TAH, developing an effective regimen to prevent thromboembolism, and determining the proper interval for transplantation after the insertion of a mechanical pump as a bridge.