The Concerted Action `Heart' European registry on clinical application of mechanical circulatory support systems: bridge to transplant

Abstract

OBJECTIVE: The goal of this paper is to identify in the field ofmechanical support as bridge to transplant, by statistical analysis,variables influencing survival during support (transplanted patients) andthe overall survival (discharged after transplant). METHODS: Clinicalfactors are analysed in 258 patients in the period 1986-1993. All variableswere analyzed by a univariate and multivariate analysis. RESULTS: Theindications for mechanically circulatory support were hemodynamicdeterioration before transplantation in 177 (69%), post acute myocardialinfarction in 40 (15%), postcardiotomy cardiogenic shock in 20 (8%), graftfailure in 12 (5%) and cardiac rejection 9 (3%). The devices implanted havebeen: pneumatic VAD in 145 cases (56%), electromechanical LVAS in 15 cases(6%), TAH in 78 cases (30%) and centrifugal pumps in 20 cases (8%). Thepatients were supported for period ranging from 2 h to 623 days (mean 18.3days +/- 43.2). The type of support was: LVAD 50 cases (20%), RVAD 3 cases(1%), BVAD 127 cases (49%), and TAH 78 cases (30%). Bleeding occurred in 84patients (32.5%), infections in 83 patients (32.1%); 21 emboliccomplications were reported in 16 patients (6%). Renal failure occurred in64 cases (25%) requiring dialysis in 33 (13%); respiratory failure in 47cases (18%); neurological impairment was noted in 22 patients (9%). Onehundred-sixty patients were transplanted (62%) and 104 ultimatelydischarged (40% out of total 258 patients and 65% out of 160 transplantedpatients). Among postoperative parameters, renal failure, TAH, neurologicalimpairment and infection shown statistical power. Some pre- andpost-operative variables were identified as independent risk factors foroverall mortality: age, indication for graft failure, all indicationsdifferent from cardiomyopathy, neurological impairment, renalinsufficiency, infection, bleeding and any type of support different fromLVAD. The improvement in the success rate in the last 2 years isstatistically significant (P = 0.0282) considering both the percentage oftransplanted patients and of discharged patients. CONCLUSIONS: The resultsare encouraging if mechanical support is performed in patients withdeterioration while awaiting transplant, when LVAD is feasible andeffective, when an ideal timing of transplant during support period isidentified.