Selection and management of ventricular assist device patients: The Muenster experience

Background: Because of the growing discrepancy between the availability of donor organs and the number of patients with end-stage heart disease who ne ed heart transplantation, a larger proportion of patients waiting for a sui table donor heart require pre-operative mechanical circulatory assistance. The criteria for the selection and management of these patients as applied at Muenster University Hospital are reviewed. Methods: The study population consists of 631 patients referred to our cent er for transplantation between January 1, 1990, and December 31, 1996. Two hundred ninety-seven patients were listed for transplantation and 157 were transplanted. Of 41 patients who underwent implantation of a ventricular as sist device (n = 34, Novacor; n = 6, TCI HeartMate; n = 1, Medos), 39 recei ved the device as a bridge to transplantation and 2 as permanent support. F or the purpose of the analysis, the study population was divided into 3 gro ups (elective bridging, urgent bridging, emergency bridging) and compared w ith heart transplant candidates who did not require mechanical circulatory assistance. Results: Patients who underwent elective or urgent assist-device implantati on were younger and had greater hemodynamic compromise than the remainder o f patients waiting for heart transplantation, as suggested by a higher func tional class and lower mean arterial pressure, cardiac index, serum sodium, and pulmonary artery wedge pressure. Survival of patients who electively u nderwent implantation of an assist device was better than that of patients who were stable on the waiting list and did not undergo heart transplantati on during follow-up. Conclusions: This finding suggests that earlier implantation of assist devi ces may facilitate resolution of organ dysfunction before heart transplanta tion.