Heart transplantation after short-term mechanical circulatory support

IntroductionShort-term ventricular assist device (VAD) implantation is a life-saving procedure in patients with refractory cardiogenic shock. The present paper provides our experience with patients we were able to bridge from this critical condition directly to heart transplantation.MethodOur group comprises 11 patients implanted a Levitronix CentriMag short-term ventricular assist device from April 2009 to October 2012 as a bridge to heart transplantation. Six (55%) patients received a biventricular assist device while five (45%) had a left-ventricular assist device implanted. The mean age of patients was 41.2 years (20–63 years). Our group of patients included eight men (73%). The underlying diagnoses included dilated cardiomyopathy (5 patients), coronary heart disease (4 patients), infective endocarditis, and primary graft failure (1 patient each). Prior to implantation, all patients received high doses of inotropes, and eight (73%) patients had mechanical ventilatory support. Six (55%) patients showed laboratory signs of liver and kidney failure, and metabolic acidosis.ResultsThe mean time from VAD implantation to putting the patient on the urgent waiting list for heart transplantation was 7.6 days (1–54 days) depending on organ function recovery. The mean duration of mechanical circulatory support was 26.7 days (8–72 days). The mean time from inclusion into the waiting list to transplantation was 19.1 days (4–52 days). One-month, six-months and one-year survivals post-transplant were 91%, 82%, and 73%, respectively.ConclusionImplantation of the CentriMag short-term ventricular assist device in patients with refractory cardiogenic shock and otherwise grim prognosis markedly increases their chances for survival. Given the relatively short waiting time in the Czech Republic, the CentriMag ventricular assist device can thus serve as a direct bridge to heart transplantation.