MECHANICAL BRIDGE TO TRANSPLANTATION/NOT THE SOLUTION OF ORGAN SHORTAGE

Abstract

The actual benefit offered by bridge to cardiac transplantation in term of improvement in the management of patients in cardiogenic shock has been evaluated in the retrospective analysis of the 11 years experience in mechanical support. The systems used have been the Nippon Zeon and Thoratec ventricular assist devices, in a left or bi-ventricular mode of support, the Novaco LVAS. The patients (n: 110) characteristics are: age 4.3± 12 (17–67) gender ratio 91M/19 F, duration of assist 45±37 days. The comparison of the 91–95 period to the 96–01 experience in an identical population (BTT in acute cardiogenic shock requiring bi-ventricular support) clearly shows the actual improvement in the clinical experience. The numbers of cases has doubled duration of assist increased from 11±28 (1–32) to 67±89 (2–360) days transplantation rate has been reduced from 85 to 69%, due to an increased overall mortality during the more prolonged period of assist. Linearized rate of death during assist has been reduced by 30%. Success rate of transplantation itself (75% and 82%) is not different. In conclusion, improved experience in MCS has permitted a rise in the volume of activity a more prolonged period of assist both being the consequence of the increased organ shortage. Nevertheless, the overall success rate of the strategy has not been improved. This observation should lead to develop the strategies of definitive implantation of systems carrying a reduced iatrogenic risk.