Bridge to cardiac transplantation: current practice

Cardiac transplantation is primarily limited by the undersupply of donor organs. An estimated 20% of all heart transplant candidates will die before a donor heart becomes available. This high pretransplant mortality rate has prompted the institution of mechanical circulatory support (MCS) as a bridge to transplant for those who develop severe cardiac failure before cardiac transplantation. Actuarial survival in MCS patients after cardiac transplantation is equal to that of transplant recipients treated with more conventional therapies. These results have encouraged researchers in the field to investigate portable devices and more permanent implants. Current practice at one transplant center offers the Novacor (Baxter Healthcare), Thoratec (Thoratec Laboratories, Inc), and Cardiowest (Cardiowest Technologies, Inc) bridge-to-transplant devices. This article will discuss each device in detail. Other areas addressed include patient selection, patient management, and quality of life (QOL).