Mechanical circulatory support as a bridge to transplant candidacy

Abdelsalam M. Elhenawy, Khaled D. Algarni, Marnie Rodger, Jane MacIver, Manjula Maganti, Robert J. Cusimano, Terrence M. Yau, Diego H. Delgado, Heather J. Ross, Vivek Rao

Research output: Contribution to journalArticlepeer-review

24 Scopus citations

Abstract

Introduction: The use of mechanical circulatory support (MCS) in nontransplant eligible candidates remains controversial. Our decision to offer MCS for nontransplant candidates has led to their reevaluation after a period of left ventricular assist device (LVAD) support. Methods: From 2001 to September 2009, we had 37 patients who received an implantable LVAD, 22 (59%) were not deemed to be transplant eligible at the time of LVAD insertion (bridge to candidacy, BTC group). Results: Fifteen (41%) patients were considered transplant eligible (bridge to transplant, BTT group) at the time of device insertion and received a HeartMate XVE (n = 7), HeartMate 2 (n = 7), or a Novacor LVAS (n = 1). In the BTC group, patients received the HeartMate XVE device (n = 11), HeartMate 2 (n = 5), or the Novacor LVAS (n = 6). The primary criterion for transplant ineligibility was refractory pulmonary hypertension (PH) in 18 patients, 3 patients did not meet our body mass index criteria (>35 kg/m 2), and 2 patients were dialysis-dependent. Six (27%) BTC patients died on support. Overall, 16/22 patients (73%) were subsequently listed for transplantation, with one listed for combined heart-lung due to refractory PH. Twelve patients (75%) underwent successful heart transplantation. Three patients died during their transplant. Overall posttransplant survival at one year shows lower survival in the BTC group compared to the BTT group (67% vs. 100%, p = 0.05). At two years and three years the survival was lower, but not statistically different (BTC vs. BTT: 67% vs. 90% and 64% vs. 87%, respectively, p = NS). Conclusions: MCS can successfully convert a large proportion of transplant-ineligible patients into acceptable candidates.

Original languageEnglish (US)
Pages (from-to)542-547
Number of pages6
JournalJournal of Cardiac Surgery
Volume26
Issue number5
DOIs
StatePublished - Sep 2011

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