Successful use of a pneumatic biventricular assist device as a bridge to transplantation in cardiogenic shock. | Read by QxMD (original) (raw)

Jaime Moriguchi, Stephanie Davis, Rhodora Jocson, Fardad Esmailian, Abbas Ardehali, Hillel Laks, Murray Kwon, Michelle Kittleson, Jon Kobashigawa, Jignesh Patel, Daniel Marelli, Mark Plunkett, Ramin Beygui, Richard Shemin

BACKGROUND: Mechanical circulatory support is a highly effective technology to maintain organ perfusion in patients with cardiogenic shock as a bridge to transplantation. Although implantation of a left ventricular assist device alone is often the preferred configuration, patients with biventricular failure and significant end-organ dysfunction often require biventricular assistance.

METHODS: Between January 2000 and September 2008, 80 patients with severe biventricular failure were accepted for heart transplantation and received a pneumatic biventricular assist devices as a bridge to transplant. Patients were retrospectively divided into 2 groups: those successfully bridged to transplant (Group A) and those who died (Group B). Patients were also divided into 2 periods of implantation: Group X (2000-2005) and Group Y (2006-2008, which used a multidiscipline selection process).

RESULTS: Overall success rate to transplantation was 71.3%, with Group Y demonstrating an 82% success to transplant rate vs 63% in Group X. One-year actuarial survival after transplant was 89% compared with 92% in patients without a ventricular assist device. There were no statistically significant laboratory parameters between Groups A and B identifying potential risk factors for poor outcome.

CONCLUSION: Biventricular assist device therapy represents an effective and reliable means of supporting selected Interagency Registry for Mechanically Assisted Circulatory Support profile 1 patients as a bridge to transplantation, with excellent success to transplant rates and post-transplant survival.