Mechanical bridge with extracorporeal membrane oxygenation and ventricularassist device to heart transplantation

The aim of this study was to evaluate the effect of double bridges with ext racorporeal membrane oxygenation (ECMO) and ventricular assist devices (VAD s) in clinical heart transplantation. Between May 1994 and October 2000, 13 4 patients underwent heart transplantation at the National Taiwan Universit y Hospital. Ten patients received ECMO or VAD support as bridges to transpl antation. The ages ranged from 3 to 63 years. The indications included card iac arrest under cardiopulmonary resuscitation in 2 and profound cardiogeni c shock refractory to conventional therapy in 8 patients. Usually ECMO was first set up as rescue therapy. If ECMO could not be weaned off after short -term (usually 1 week) support, suitable VADs (HeartMate or Thoratec VAD) w ere implanted for medium-term or long-term support. Five patients received ECMO support as emergency rescue for 2 to 9 days, and then moved to Thorate c VAD for 8, 49, and 55 days, respectively, or centrifugal VAD for 31 days, or HeartMate VAD for 224 days. They all survived. The survival rate of dou ble bridges with ECMO and VAD was 100%. In postcardiotomy cardiogenic shock , circulatory collapse from acute myocardial infarction or myocarditis, ECM O is the device of choice for short-term support. If heart transplantation is indicated, VADs should replace ECMO for their superiority as a bridge to heart transplantation. Our preliminary data of double bridges with ECMO an d VAD revealed good results and were reliable and effective bridges to tran splantation.