Bridge to transplantation: The Penn State experience

Background. During the past decade, ventricular assist devices as a bridge to transplantation have moved from the experimental arena to accepted thera py. Our institution has been at the forefront of the development of this te chnology and consequently has had extensive experience with the devices tha t are currently approved by the Food and Drug Administration for use as a b ridge to heart transplantation. Methods. The successful management of patients with assist devices hinges o n patient and device selection as well as perioperative management strategi es. The routine use of agents such as aprotinin, vasopressin, milrinone, an d inhaled nitric oxide has contributed to successful management of these pa tients. We present our perspectives on the advantages and disadvantages of the Thermo-Cardiosystems HeartMate 1000 IP device and the Thoratec (Pierce- Donachy) system. We also discuss our protocols and methods for patient sele ction, preoperative preparation, intraoperative strategy, and postoperative management that have resulted in improved patient outcomes. Results. More than 60 device implantation procedures have been performed si nce the inception of our bridge to transplantation program. During this tim e, two thirds of our patients were successfully bridged to transplantation. Of these patients, 92% were alive at 1 month after transplantation, and 83 % were alive at 1 year after transplantation. Conclusions. Both support systems are effective in supporting patients to h eart transplantation. We have developed a preference for the Thermo-Cardios ystems HeartMate 1000 IP device because of its portability and associated b etter quality of life. However, the Thoratec device is the more versatile d evice, and circumstances exist when its use is clearly advantageous. In our institutional experience, outcome for bridging to transplantation has not been device dependent. (C) 1999 by The Society of Thoracic Surgeons.