Transfer of patients receiving advanced mechanical circulatory support

Objective: Improving results with ventricular assist devices have led to th eir wider clinical application. Centers can stabilize, support, and wean or transfer patients to regional transplant centers, Methods: Prospectively collected data were reviewed to evaluate the clinica l results of patients transferred to our institution while receiving advanc ed mechanical circulatory support. Results: Since 1993, 16 patients were accepted while receiving support with either extracorporeal membrane oxygenation or a ventricular assist device. The 10 male and 6 female patients ranged in age from 9 to 60 years (mean, 42.1 years). Thirteen had had cardiac surgical procedures, two had acute my ocardial infarctions, and one had myocarditis. The distance transported ran ged from 0.2 to 309 miles (mean, 132 miles). Twelve patients were transferr ed by ground, and 4 were transported by air. Seven patients were originally supported with extracorporeal membrane oxygenation, 6 with centrifugal pum ps, and 3 with ABIOMED ventricular assist devices (ABIOMED, inc, Danvers, M ass). Two patients had clinical complications during transfer, and one had a cerebrovascular accident, recovered, was weaned, and survived. A second p atient had hemodynamic deterioration. There were no technical complications associated with transport. Six patients were left on the original support device; 3 of the 6 were weaned and survived, and 3 died during support. The 10 remaining patients were switched to other ventricular assist devices: 9 patients to Thoratec devices (Thoratec Laboratories, Pleasanton, Calif) an d 1 patient to a Novacor device (Baxter Healthcare Corp, Novacor Division, Oakland, Calif). Six of the 10 patients underwent transplantation and survi ved. Four patients died while being supported by the devices. Nine patients were discharged, with 1 late death at 29 months. Eight patients are alive 3 to 65 months after discharge. Conclusions: These data suggest that patients receiving advanced support ca n be moved between clinical centers with acceptable risks. Because 33% of t he survivors were weaned, transplantation is not required for survival.