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The Annals of Thoracic Surgery, Vol 57, 1416-1422, Copyright © 1994 by The Society of Thoracic Surgeons
OH Frazier, MP Macris, TJ Myers, JM Duncan, B Radovancevic, SM Parnis and DA Cooley
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.(ABSTRACT TRUNCATED AT 250 WORDS)
ARTICLES
Improved survival after extended bridge to cardiac transplantation
Department of Cardiovascular Research, Texas Heart Institute/St. Luke's Episcopal Hospital, Houston.
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