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Cardiac transplantation after mechanical circulatory support: a Canadian perspective
R G Masters1, P J Hendry, R A Davies
1Division of Surgery, University of Ottawa Heart Institute, Ottawa Civic Hospital, Ontario, Canada.
The Annals of Thoracic Surgery
|June 1, 1996
Summary
Cardiac transplantation outcomes were analyzed in patients with and without mechanical circulatory support. While post-transplant infection rates were higher and survival lower in the mechanical support group, outcomes were acceptable given the alternative of certain death.
Area of Science:
- Cardiology
- Transplantation Medicine
- Mechanical Circulatory Support
Background:
- Assessing the efficacy of cardiac transplantation following mechanical circulatory support (MCS) is crucial for end-stage heart failure management.
- Previous studies have not comprehensively compared outcomes across various MCS devices prior to heart transplantation.
Purpose of the Study:
- To evaluate the relative efficacy of cardiac transplantation in patients who received mechanical circulatory support versus those who did not.
- To compare survival rates and complication frequencies between different groups of heart transplant recipients based on pre-transplant support.
Main Methods:
- A retrospective review of 209 cardiac transplant patients from 1984 to 1995.
- Patients were categorized into three groups: oral medications (Group 1), intravenous inotropic support (Group 2), and mechanical circulatory support (Group 3).
- Group 3 was further subdivided based on the type of MCS: intraaortic balloon pump (3A), ventricular assist device (3B), and total artificial heart (3C).
Main Results:
- Group 3 (MCS) experienced significantly higher infection rates (56%) compared to Group 1 (28%) and Group 2 (32%).
- Survival to discharge was lower for Group 3 (71.7%) than for Group 1 (90.9%) and Group 2 (88.3%).
- Among MCS subgroups, survival to discharge was highest for intraaortic balloon pump (84.6%) and lowest for total artificial heart (63.1%), though not statistically significant.
Conclusions:
- Cardiac transplantation following mechanical support provides acceptable outcomes for patients with no other viable treatment options.
- Careful patient selection and optimized perioperative management are essential for improving results in this high-risk population.
- The type of mechanical support may influence post-transplant outcomes, highlighting the need for further investigation.