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Ranjit John
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Yoshifumi Naka
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Right arrow Transplantation - heart

J Thorac Cardiovasc Surg 2004;127:1309-1316
© 2004 The American Association for Thoracic Surgery

Cardiopulmonary support and physiology

Bridging to transplant with the HeartMate left ventricular assist device: The Columbia Presbyterian 12-year experience

Jeffrey A. Morgan, MDa, Ranjit John, MDa, Vivek Rao, MD, PhDb, Alan D. Weinberg, MSa, Brian J. Lee, BSa, Pamela A. Mazzeo, BAa, Margaret R. Flannery, ANPa, Jonathan M. Chen, MDa, Mehmet C. Oz, MDa, Yoshifumi Naka, MD, PhDa,*

a Department of Surgery, Division of Cardiothoracic Surgery, Columbia University, College of Physicians and Surgeons, New York, NY, USA
b Department of Surgery, Division of Cardiac Surgery, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada

Received for publication March 20, 2003; revisions received July 20, 2003; accepted for publication July 31, 2003.

* Address for reprints: Yoshifumi Naka, MD, PhD, Columbia University, College of Physicians and Surgeons, 177 Fort Washington Ave, Milstein Hospital 7GN-435, New York, NY 10032, USA
yn33{at}columbia.edu

OBJECTIVE: Implantation of a left ventricular assist device as a bridge to transplantation has become an acceptable approach for patients with end-stage heart failure. Our long-term results with 3 Thoratec HeartMate devices are presented to outline improvements in successful bridging to transplantation and post-transplant survival.

METHODS: From August 1990 through January 2003, 243 patients underwent implantation of Thoratec HeartMate devices as a bridge to transplantation. This included 52 (21.4%) pneumatic devices, 17 (7.0%) dual-lead vented electric devices, and 174 (71.6%) single-lead vented electric devices.

RESULTS: Mean age was 49.7 ± 13.7 years. Mean support time was 78.1 ± 82.9 days (0-541). Bridging success increased from 63.5% (n = 33) for pneumatic devices to 64.7% (n = 11) for dual-lead vented electric devices and 72.4% (n = 126) for single-lead vented electric devices (P = .005). Posttransplant 1-, 3-, and 5-year actuarial survival increased from 87.5%, 78.1%, and 71.9% in patients with pneumatic devices to 91.5%, 86.9%, and 81.3%, respectively, for patients with single-lead vented electric devices. Device infection and malfunction occurred in 17.7% (n = 43) and 12.8% (n = 31) of patients, respectively.

CONCLUSIONS: Successful bridging to transplantation and posttransplant survival has improved over time. Left ventricular assist devices have become increasingly more effective in bridging patients with end-stage heart failure to transplantation. This is likely due to a combination of better patient selection, improvements in clinical practice, and evolution in device design.




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