IMPROVED SURVIVAL AFTER EXTENDED BRIDGE TO CARDIAC TRANSPLANTATION

In the past, left ventricular assist device (LVAD) support was frequen tly plagued by complications; thus, bridge to transplantation times we re kept short. Increasing evidence suggests that extended bridging pro vides greater benefit due to improved end-organ perfusion and, thus, g enerally improved physical condition. To assess whether extended bridg ing translates into improved long-term survival after transplantation, we reviewed our experience with the HeartMate 1000 IP LVAD (Thermo Ca rdiosystems, Inc, Woburn, MA). Since January 1988, 19 patients (mean a ge, 45 +/- 9 years) have undergone extended bridging (mean time, 106 /- 57 days). Their mean weight was 82 +/- 16 kg, and their mean body s urface area was 2.0 +/- 0.2 m(2). We define ''extended'' as the length of support necessary for systemic organ recovery after prolonged hear t failure. During support, average pump flow indices ranged from 2.3 t o 3.3 L . min(-1) . m(-2), and all patients underwent physical rehabil itation. Between the time of LVAD implantation and explantation, the m ean serum creatinine value decreased from 1.63 +/- 0.6 to 1.25 +/- 0.6 mg/dL (p = not significant), and the mean serum total bilirubin value decreased from 2.8 +/- 2.0 to 0.63 +/- 0.11 mg/dL (p < 0.05). All but 1 patient improved from New York Heart Association class IV to class I. Device-related complications were minimal. Twelve control patients (''de facto randomized'') who did not receive the LVAD also were evalu ated: actuarial survival at 1 year was 0% (p < 0.05); 3 (25%) underwen t transplantation and died within 2 months; 9 (75%) died before transp lantation. Actuarial survival in our LVAD group was 100% at 1 and 2 ye ars (p < 0.05 versus controls). These results show that extended bridg ing normalized end-organ performance and physical condition, thus impr oving long-term survival.