Successful bridge to cardiac transplantation using conventional cardiac assist devices - University of Alberta experience

Background: Cardiac transplantation is the established therapy of choice for end-stage heart disease. Mechanical circulatory support has become an important, viable option in stabilizing and bridging critically ill potential recipients for transplantation. We present the experience of one Canadian institution with conventional cardiac assist devices used as a bridge for heart transplant recipients in cardiogenic shock. Methods: A retrospective review of all adult cardiac transplant recipients performed from July 1985 through September 2000 was carried out. Patients in cardiogenic shock deemed to be potential transplant recipients, who were mechanically supported, were examined. Those who subsequently received an organ were identified, and survival analyzed. A chart review and transplant database was employed. Results: A total of 308 heart transplants were performed. Of the 13 recipients bridged to transplant with IABP, 92.3% (n=12) survived >30 days, 84.6% (n=ll) were alive and well out of hospital >1 year. Eleven patients were bridged to transplant with ECMO or VAD. Overall survival following transplantation was 81.8% (n=9) beyond 30 days; 72.7% (n=8) were alive and well out of hospital >1 year. Conclusions: These data indicate that selected patients in cardiogenic shock supported with conventional, readily available and inexpensive mechanical assistance may be successfully transplanted. While the patient population is small, it is possible to successfully bridge patients in cardiogenic shock to cardiac transplantation using IABP, ECMO, and VAD with acceptable survival following transplantation.