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Ann Thorac Surg 1994;57:1416-1422
© 1994 The Society of Thoracic Surgeons
evi
, MDDepartments of Cardiovascular Research and Transplantation, Texas Heart Institute/St. Luke's Episcopal Hospital, Houston, Texas, USA
* Address reprint requests to Dr Frazier, Texas Heart Institute, PO Box 20345, Houston, TX 77225.
In the past, left ventricular assist device (LVAD) support was frequently plagued by complications; thus, bridge to transplantation times were kept short. Increasing evidence suggests that extended bridging provides greater benefit due to improved end-organ perfusion and, thus, generally improved physical condition. To assess whether extended bridging translates into improved long-term survival after transplantation, we reviewed our experience with the HeartMate 1000 IP LVAD (Thermo Cardiosystems, Inc, Woburn, MA). Since January 1988, 19 patients (mean age, 45 ± 9 years) have undergone extended bridging (mean time, 106 ± 57 days). Their mean weight was 82 ± 16 kg, and their mean body surface area was 2.0 ± 0.2 m2. We define "extended" as the length of support necessary for systemic organ recovery after prolonged heart failure. During support, average pump flow indices ranged from 2.3 to 3.3 L · min–1 · m–2, and all patients underwent physical rehabilitation. Between the time of LVAD implantation and explantation, the mean serum creatinine value decreased from 1.63 ± 0.6 to 1.25 ± 0.6 mg/dL (p = not significant), and the mean serum total bilirubin value decreased from 2.8 ± 2.0 to 0.63 ± 0.11 mg/dL (p < 0.05). All but 1 patient improved from New York Heart Association class IV to class I. Device-related complications were minimal. Twelve control patients ("de facto randomized") who did not receive the LVAD also were evaluated: actuarial survival at 1 year was 0% (p < 0.05); 3 (25%) underwent transplantation and died within 2 months; 9 (75%) died before transplantation. Actuarial survival in our LVAD group was 100% at 1 and 2 years (p < 0.05 versus controls). These results show that extended bridging normalized end-organ performance and physical condition, thus improving long-term survival.
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