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Ann Thorac Surg 1989;47:108-112
© 1989 The Society of Thoracic Surgeons

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Articles

Circulatory support with a centrifugal pump as a bridge to cardiac transplantation

^a Department of Surgery, Division of Cardiothoracic Surgery, Washington University School of Medicine, St. Louis, Missouri U.S.A.
^b Department of Medicine, Division of Cardiology, Washington University School of Medicine, St. Louis, Missouri U.S.A.
^c Department of Pathology, Washington University School of Medicine, St. Louis, Missouri U.S.A.

^_* Address reprint requests to Dr Bolman, 3108 Queeny Tower, 4989 Barnes Hospital Plaza, St. Louis, MO 63110.

Since January 1985, the Heart Transplant Program at Washington University Medical Center, St. Louis, has performed 89 heart transplantations in 86 patients. Twenty patients (23%) have required preoperative mechanical support of circulation or respiration prior to transplantation. The Bio-Medicus centrifugal pump (Bio-Pump) formed the basis of our circulatory support system during the period of this report. Nine patients were placed on the Bio-Pump with the intention of bridging them to transplantation. Six patients required left ventricular assistance; in 2, the device was inserted because they could not be weaned from cardiopulmonary bypass. Two patients required biventricular assistance, 1 because she could not be weaned from cardiopulmonary bypass at the end of a cardiac operation. Extracorporeal membrane oxygenation was necessary in 1 patient for right ventricular decompensation and cardiac arrest four hours after orthotopic cardiac transplantation. One of these 9 patients died on circulatory support, and in another, a complication developed that precluded transplantation. The remaining 7 patients (78%) underwent a successful transplant procedure after an average of 1.6 days of circulatory support (range, 0,5 to three days), and all are long-term survivors of transplantation. There has been 1 late death at 17 months from a cerebrovascular hemorrhage. In summary, the centrifugal pump provides excellent short-term circulatory support for individuals who would otherwise die before cardiac transplantation.

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