MECHANICAL CIRCULATORY SUPPORT AFTER ORTHOTOPIC HEART-TRANSPLANTATION

Frequently the only therapy for primary graft- and right heart failure , as well as low output syndrome from acute of chronic rejection, is i mplantation of a mechanical circulatory support system, until recompen sation or retransplantation. At our institution, mechanical assist dev ices were implanted in 25 heart recipients for a cute rejection (n=9), primary graft failure (n=7), acute right heart failure (n=7), and chr onic rejection with low output syndrome (n=2). Patients (pts) with pri mary graft failure (n=3) received an intraaortic balloon pump (IABP), one pt an IABP plus Abiomed(R)-System for left ventricular support one pt the Thoratec(R)-System for biventricular support. Patients with ri ght heart failure (RHF) received the Biomedicus(R) centrifugal pump fo r right ventricular support Nine pts suffered from acute rejection. Si x pts received an IABP, one the Biomedicus(R) as femoro-femoral bypass , one the Abiomed(R)-System for biventricular support, two the Thorate c(R)-System for biventricular support and two within this group switch ed from the Biomedicus(R) pump to the Thoratec(R)-System for biventric ular support Patients with chronic graft failure (n=2) received the No vacor(R)-System (LVAD) for left ventricular support, one received a To jobo(R)-System and an oxygenator for biventricular support post corona ry artery bypass surgery. Support time ranged from 0.5-h to 73 days. F ive pts were weaned. Two (8%) of 25 pts were retransplanted, 18 (72%) died in spite of mechanical support from multiple organ failure. The u se of a mechanical assist device after heart transplantation is encour aging only in the case of early right heart failure, as well as primar y and chronic graft failure. In view of the poor results, the use of m echanical assist devices should not be recommended in the case of hear t failure caused by acute rejection.