OBJECTIVE: This study examines short-term mechanical assist device support for cardiac transplant patients and compares their outcomes with nontransplant patients requiring similar support. METHODS: Of 350 cardiac transplant patients at our institution, 7 patients required mechanical ventricular assistance with the Abiomed BVS5000 assist device (Abiomed, Inc, Danvers, Mass) after transplant secondary to severe acute rejection with cardiogenic shock (n = 4) or primary graft failure (n = 3). Recovery of ventricular function, survival to discharge, and complications were determined for the transplant group and compared with a second group comprising all other patients supported with the BVS5000 at our institution (n = 15). Additionally, the results of prior series reporting mechanical ventricular support of the failing transplant heart are reviewed. RESULTS: Demographics and duration of support were similar between the groups. The transplant group had a higher wean rate from device relative to the nontransplant group (100% versus 13%; P < 0.01). Five of 7 in the transplant group achieved survival to discharge (71%), relative to 5 of 15 in the nontransplant group (33%). Complications between the two groups were similar, although the transplant group experienced a higher rate of renal insufficiency (57% versus 13%, P = 0.05). CONCLUSION: Severe acute rejection with cardiogenic shock and primary graft failure are two conditions that may warrant mechanical ventricular support in the cardiac transplant patient. Transplant patients with these conditions have a high rate of ventricular functional recovery, greater than nontransplant patients supported with the same device and for a similar period of time. Although the incidence of renal insufficiency was higher, the majority of transplant patients who were supported with the BVS5000 achieved survival to discharge.
OBJECTIVE: This study examines short-term mechanical assist device support for cardiac transplant patients and compares their outcomes with nontransplant patients requiring similar support. METHODS: Of 350 cardiac transplant patients at our institution, 7 patients required mechanical ventricular assistance with the Abiomed BVS5000 assist device (Abiomed, Inc, Danvers, Mass) after transplant secondary to severe acute rejection with cardiogenic shock (n = 4) or primary graft failure (n = 3). Recovery of ventricular function, survival to discharge, and complications were determined for the transplant group and compared with a second group comprising all other patients supported with the BVS5000 at our institution (n = 15). Additionally, the results of prior series reporting mechanical ventricular support of the failing transplant heart are reviewed. RESULTS: Demographics and duration of support were similar between the groups. The transplant group had a higher wean rate from device relative to the nontransplant group (100% versus 13%; P < 0.01). Five of 7 in the transplant group achieved survival to discharge (71%), relative to 5 of 15 in the nontransplant group (33%). Complications between the two groups were similar, although the transplant group experienced a higher rate of renal insufficiency (57% versus 13%, P = 0.05). CONCLUSION: Severe acute rejection with cardiogenic shock and primary graft failure are two conditions that may warrant mechanical ventricular support in the cardiac transplant patient. Transplant patients with these conditions have a high rate of ventricular functional recovery, greater than nontransplant patients supported with the same device and for a similar period of time. Although the incidence of renal insufficiency was higher, the majority of transplant patients who were supported with the BVS5000 achieved survival to discharge.
Authors: Vidyadhar Lad; Abdelsalam Elhenawy; Steve Harwood; Jane Maciver; Mitesh Vallabh Badiwala; Mark Vallelonga; Terrence M Yau; Robert J Cusimano; Diego H Delgado; Heather J Ross; Vivek Rao Journal: Can J Cardiol Date: 2010-11 Impact factor: 5.223
Authors: Moheb Ibrahim; Paul Hendry; Roy Masters; Fraser Rubens; B-Khanh Lam; Marc Ruel; Ross Davies; Haissam Haddad; John P Veinot; Thierry Mesana Journal: Can J Cardiol Date: 2007-04 Impact factor: 5.223