Circulatory assistance while waiting for heart transplantation - Patient selection and choice of the assist system

Two clinical situations: Mechanical circulatory assistance can be indicated in two clinical situations: i) patients on the waiting list for heart tran splantation who have chronic heart failure unresponsive to drug therapy and whose clinical status worsens; ii) patients with acute heart failure. Indications: The exact indications for mechanical circulatory assistance ar e difficult to establish. Hemodynamic criteria are no longer sufficient Cir culatory assistance may be proposed for chronic heart failure patients with a high risk of death or in a situation of acute deterioration. Among these patients, several risk factors can be used to establish scores that have a better predictive value than risk factors taken alone. Two predictive mode ls have been recently established. The first one takes into account 7 indep endent variables. etiology, heart rate at rest left ventricle ejection frac tion, mean blood pressure, intraventricular rhythm disorder, VO(2)max and s erum sodium). In addition to these variables, the second model also include s pulmonary wedge pressure. In selected patients with acute heart failure, circulatory assistance is needed as early as possible to avoid irreversible multiple organ failure. The crucial problem is rapid assessment of the fea sibility of heart transplantation. Preoperative mortality risk factors: Several variables can be used to predi ct survival in candidates for mechanical circulatory assistance on the hear t transplantation waiting list They include hemodynamic criteria, renal fun ction, liver function, preoperative infection and the emergency nature of t he need for circulatory assistance. Choice of the assist system: The choice depends both on the patient (surfac e area is important) and the underlying disease. (C) 2000, Masson, Paris.