THE CONCERTED ACTION HEART EUROPEAN REGISTRY ON CLINICAL-APPLICATION OF MECHANICAL CIRCULATORY SUPPORT SYSTEMS - BRIDGE TO TRANSPLANT

Objective: The goal of this paper is to identify in the field of mecha nical support as bridge to transplant, by statistical analysis, variab les influencing survival during support (transplanted patients) and th e overall survival (discharged after transplant). Methods: Clinical fa ctors are analysed in 258 patients in the period 1986-1993. All variab les were analyzed by a univariate and multivariate analysis. Results: The indications for mechanically circulatory support were hemodynamic deterioration before transplantation in 177 (69%), post acute myocardi al infarction in 40 (15%), postcardiotomy cardiogenic shock in 20 (8%) , graft failure in 12 (5%) and cardiac rejection 9 (3%). The devices i mplanted have been: pneumatic VAD in 145 cases (56%), electromechanica l LVAS in 15 cases (6%), TAH in 78 cases (30%) and centrifugal pumps i n 20 cases (8%). The patients were supported for period ranging from 2 h to 623 days (mean 18.3 days +/- 43.2). The type of support was: LVA D 50 cases (20%), RVAD 3 cases (1%), BVAD 127 cases (49%), and TAH 78 cases (30%). Bleeding occurred in 84 patients (32.5%), infections in 8 3 patients (32.1%); 21 embolic complications were reported in 16 patie nts (6%). Renal failure occurred in 64 cases (25%) requiring dialysis in 33 (13%); respiratory failure in 47 cases (18%); neurological impai rment was noted in 22 patients (9%). One hundred-sixty patients were t ransplanted (62%) and 104 ultimately discharged (40% out of total 258 patients and 65% out of 160 transplanted patients). Among postoperativ e parameters, renal failure, TAH, neurological impairment and infectio n shown statistical power. Some pre- and post-operative variables were identified as independent risk factors for overall mortality: age, in dication for graft failure, all indications different from cardiomyopa thy, neurological impairment, renal insufficiency, infection, bleeding and any type of support different from LVAD. The improvement in the s uccess rate in the last 2 years is statistically significant (P = 0.02 82) considering both the percentage of transplanted patients and of di scharged patients. Conclusions: The results are encouraging if mechani cal support is performed in patients with deterioration while awaiting transplant, when LVAD is feasible and effective, when an ideal timing of transplant during support period is identified. Copyright (C) 1997 Elsevier Science B.V.