RISK STRATIFICATION IN PATIENTS BRIDGED TO CARDIAC TRANSPLANTATION

Patient selection is considered one of the most important factors infl uencing success in bridge to transplant procedures. However, to date i t has been difficult to identify predictors of mortality in this popul ation using univariate or multivariate analysis. In 1988, we developed a scoring system using 21 clinical variables that could be calculated rapidly at the bedside while evaluating potential candidates. Points were designated to these variables using a scale of 1 to 3, 1 having t he least adverse effect on survival and 3 the most. Patients received a value of 0 for each variable that did not apply. This scoring system was used in a retrospective analysis for 15 bridge to transplant pati ents. The results showed a significant difference (p < 0.003) between the 8 survivors (mean score, 5.75 +/- 2.19) and the 7 nonsurvivors (me an score, 11.71 +/- 3.45). Since 1989, we have prospectively calculate d the scores in an additional 27 patients. Based on the score, all 42 patients were divided into three groups: group I had scores of 1 to 5; group II, 6 to 10; and group III, 11 to 16. The mean score for group I (16 patients) was 3.69 +/- 1.25. All group I patients survived. Group II patients (n = 15) had a mean score of 7.87 +/- 1.36 and a survival rate of 53%. The mean score for group III (n = 11) was 13 +/- 1.73. T hirty-six percent of these patients survived. Comparison of survival a nd mean scores among the three groups was statistically significant (p < 0.0001). The mean score was 5.86 +/- 3.15 for the 28 survivors and 11.14 +/- 3.01 for the 14 nonsurvivors (p < 0.0001). Proper patient se lection for bridging to transplantation involves predevice evaluation of multiple clinical factors. This scoring system can be used to strat ify patients based on the risk of nonsurvival, thus providing clinicia ns with an additional tool on which to base their decisions.