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Ann Thorac Surg 2001;71:S114-S115
© 2001 The Society of Thoracic Surgeons

Session 2: bridging to transplant and alternatives to transplant

Discussion of bridging to transplant and alternatives to transplant

Jack G. Copeland, III, MD, Moderator, Alain J. Pavie, MD, Moderator, Aly El-Banayosy, MD, Panelist, Mehmet C. Oz, MD, Panelist

Presented at the Fifth International Conference on Circulatory Support Devices for Severe Cardiac Failure, New York, NY, Sept 15–17, 2000.

DR ROLAND HETZER (Berlin, Germany):

I would like to ask what you as a surgeon do with a patient who is unconscious. This is one of the most difficult situations to decide upon, whether to implant an assist device and which device, and also whether there are any means to define whether the patient has significant cerebral damage or not.

DR MEHMET C. OZ (New York, NY):

I will give you our philosophy. The first is we do not look for any objective neurologic examination issues. We just look to see if they move spontaneously and how long after their arrest did they move. If it is a postcardiotomy support patient, we would lighten sedation, make sure they wake up a little bit. If they had a cardiac arrest, which prompts many physicians to have called us to begin with, we look to see they move. The movement does not have to be purposeful, just not decerebrate moving.

On the other hand, the second point that you bring up is a good one. Is there a bridge technique we use to waken these patients? No. It is a binary decision: Either they are salvageable or they are not. Once we decide to put a device in them, we put the device that they are going to end up with. We would not insert a bridge device and then later on if they wake up transition them. Because that is a use of resources and plus it reduces the chance of their long-term survival.

DR ALY EL-BANAYOSY (Bad Oeynhausen, Germany):

It depends on where the cardiopulmonary resuscitation (CPR) occurs. When the resuscitation occurs in our hospital in which case we can look at the period of resuscitation, that might mean we can go on to support the patient with a Thoratec . . . [Full Text of this Article]






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