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The Journal of Thoracic and Cardiovascular Surgery, Vol 92, 994-1004, Copyright © 1986 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
JL Pennock, WS Pierce, DB Campbell, WE Pae Jr, D Davis, FA Hensley, WE Richenbacher and JA Waldhausen
Improvements in both mechanical circulatory support devices and immune
therapy promise a wider use of sequential mechanical support as a bridge to
orthotopic cardiac transplantation. The intra-aortic balloon pump, the left
and right ventricular assist pumps, and the pneumatic artificial heart
represent the range of devices capable of keeping a patient alive who is
awaiting a donor organ. The major difficulty in using circulatory support
devices is infection, which is caused by their required percutaneous tubes.
We report here our experiences with mechanical circulatory support devices
as a bridge to cardiac transplantation. In a series of 31 consecutive
transplant procedures, six patients have required preoperative mechanical
circulatory support. The intra-aortic balloon pump was used in two patients
for 2 and 14 days, respectively, before transplantation. Both patients are
well 10 and 11 months after the transplant procedure. Two patients required
the left ventricular assist device for 11 and 21 days and are alive 3 weeks
and 8 months, respectively, after transplantation. One patient was
supported by the pneumatic artificial heart for 10 days before a donor
heart became available but died of septic shock 17 days after
transplantation. A second patient received a pneumatic artificial heart 7
days after transplantation when the heart transplant failed. He has been in
stable condition for 45 days but is recovering from renal failure. Our
early experiences indicate that either partial or total mechanical support
as a bridge to transplantation is successful if overwhelming sepsis or
renal failure can be avoided.
ARTICLES
Mechanical support of the circulation followed by cardiac transplantation
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