HEARTMATE LEFT-VENTRICULAR ASSIST DEVICE AS BRIDGE TO HEART-TRANSPLANTATION

Background. Because of the limited supply of donor hearts, prospective recipients continue to die while on the waiting list for heart transp lantation. Use of longterm mechanical circulatory support devices as a bridge to transplantation may reduce this mortality. However, with th e present state of technology, continued clinical evaluation of the va rious long-term, mechanical circulatory support devices available is m andatory. Methods. Sixteen patients were bridged with the HeartMate le ft ventricular assist device (LVAD) to heart transplantation for New Y ork Heart Association functional class IV cardiac failure. Twelve pneu matic and six electric devices were used. The mean cardiac index and t he mean pulmonary vascular resistance of the patient cohort were 1.71. min(-1).m(-2) and 3.1 Wood units, respectively. Results. The mean LVAD support time per transplanted patient was 237 days, with a cumulative LVAD support time of about 7.2 years. Bleeding was the main operative and postoperative complication. Two patients suffered from neurologic complications and there were two major incidents of device malfunctio n. Twelve patients (75%) now have received a transplant, 3 (19%) ire a waiting a transplant, and in 1 patient (6%), the device was explanted after spontaneous left ventricular recovery. Eleven of the 12 patients who received a transplant are alive and doing well. The HeartMate LVA D gave adequate circulatory support over extended periods of time and reversed the vital organ dysfunction. Since the start of the LVAD prog ram, only 1 patient has died on our heart transplantation waiting list , compared to nine deaths in the 2 preceding years. Conclusions. The H eartMate LVAD bridge to heart transplantation can be performed with lo w post-LVAD implantation and posttransplantation mortality and offers 1- and 2-year posttransplantation actuarial survival rates comparable to those for nonbridged heart transplant recipients. (C) 1998 by The S ociety of Thoracic Surgeons.