MECHANICAL BRIDGE TO TRANSPLANTATION - WHEN IS TOO EARLY - WHEN IS TOO LATE

Background. Optimal timing of implantation of a mechanical circulatory support system in the treatment of acute cardiogenic shock is still u nsettled. The issue has been addressed in a retrospective analysis of a group of 98 patients in cardiogenic shock refractory to medical ther apy who were candidates for cardiac transplantation, admitted from 198 7 to 1994. Methods. The treatment included reinforced inotropic suppor t by addition of phosphodiesterase inhibitors to sympathomimetic agent s. The patients who did not improve were immediately brought to the op erating room for mechanical circulatory support system implantation. R esults. The overall survival in the group of 28 patients selected for mechanical bridge is 50%. No predictive factors of death or multiorgan failure while on the device could be identified, suggesting a lack of contraindications to mechanical circulatory support system implantati on. Conclusions. The high death rate in patients maintained on medical therapy because of initial improvement as they are awaiting transplan tation suggests the benefit of a rapid semielective implantation of an intracorporeal device.