Heart transplantation in patients requiring preoperative mechanical support

Since January 1985, the members of the Heart Transplant Program at Washington University Medical Center, St. Louis, have performed 53 transplants in 50 patients. Thirteen patients have required preoperative mechanical support. These patients ranged in age from 32 to 58 years, with a mean of 47 years. Seven patients had undergone a total of 12 prior cardiac surgical procedures. Preoperative diagnosis was coronary artery disease in nine patients, cardiomyopathy in three, and valvular heart disease in one. Two patients had mechanical ventilatory support before operation. Five patients required preoperative intraaortic balloon counterpulsation (IABP). Five patients required left ventricular assistance with the Bio-Medicus centrifugal pump (Bio-Medicus Inc., Eden Prairie, Minnesota). Two of these patients had the left ventricular assist device (LVAD) inserted at the end of a failed cardiac procedure. One patient required the extracorporeal membrane oxygenator (ECMO) for right ventricular decompensation and cardiac arrest 4 hours after a seemingly successful orthotopic transplantation. Twelve of the 13 patients (92%) who required mechanical assistance of circulation and/or respiration before operation underwent a successful transplant. One patient who had IABP support perioperatively did not survive surgery. All patients who had a bridge to transplantation with the LVAD and the one patient with a bridge to transplant with ECMO are long-term survivors of transplantation. There has been one late death from cardiac causes in a patient who had IABP support before operation; the death was presumed to be from acute rejection, though this could not be documented at autopsy. Actuarial survival in this group is 82% at 12 months.(ABSTRACT TRUNCATED AT 250 WORDS)