Long-term Circulatory Support Research Articles

Mechanical circulatory support devices for patients with small anthropometric indicators

Mechanical circulatory support (MCS) devices, designed specifically for patients with small anthropometric parameters, are now emerging. A detailed systematic literature review of existing systems for long-term circulatory support in this patient cohort was conducted. Circulatory support devices and their main technical and biological characteristics were studied in detail. Despite significant scientific and technological progress, there is still no technology for creating an assist pump to support patients with small body surface area (BSA), given the wide range of patient sizes, increased cardiovascular demand due to growth, as well as anatomical and physiological heterogeneity of congenital heart disease.

German Heart Surgery Report 2022: The Annual Updated Registry of the German Society for Thoracic and Cardiovascular Surgery.

Based on a longtime voluntary registry, founded by the German Society for Thoracic and Cardiovascular Surgery (GSTCVS/DGTHG) in 1980, well-defined data of all cardiac, thoracic, and vascular surgery procedures performed in 78 German heart surgery departments during the year 2022 are analyzed. Under the decreasing interference of the worldwide coronavirus disease 2019 pandemic, a total of 162,167 procedures were submitted to the registry. A total of 93,913 of these operations are summarized as heart surgery procedures in a classical sense. The unadjusted in-hospital survival rate for the 27,994 isolated coronary artery bypass grafting procedures (relationship on-/off-pump 3.2:1) was 97.5%. For the 38,492 isolated heart valve procedures (20,272 transcatheter interventions included) it was 96.9%, and for the registered pacemaker/implantable cardioverter-defibrillator procedures (19,531) 99.1%, respectively. Concerning short- and long-term circulatory support, a total of 2,737 extracorporeal life support/extracorporeal membrane oxygenation implantations, respectively 672 assist device implantations (L-/ R-/ BVAD, TAH) were registered. In 2022, 356 isolated heart transplantations, 228 isolated lung transplantations, and 5 combined heart-lung transplantations were performed. This annually updated registry of the GSTCVS/DGTHG represents voluntary public reporting by accumulating actual information for nearly all heart surgical procedures in Germany, constitutes advancements in heart medicine, and represents a basis for quality management for all participating institutions. In addition, the registry demonstrates that the provision of cardiac surgery in Germany is up to date, appropriate, and nationwide patient treatment is always available.

Udaljeni rezultati nakon transplantacije srca - iskustvo transplantacionog programa Republike Srbije

Introduction/Aim: Heart transplantation (HTX) is the gold standard for the treatment of patients in symptomatic terminal stadium of heart failure. This study aimed to investigate the long-term results of the HTX and to determine the independent survival predictors after HTX within The Serbian Heart Transplantation program. Methods: A retrospective observational study was performed. The study included 44 patients that were subjected to heart transplantation from 2013 to 2021 within the The Serbian Heart Transplantation program. All the patients were included in the National heart transplantation waiting list according to the contemporary ISHLT criteria. The study included all the patients subjected to HTX, as well as the ones who received long-term circulatory support preoperatively. The data were obtained from the medical history records and follow-up visits. Results: The average survival of all patients was 1611.8 days (1306.9 - 1916.7). The median length of patient follow-up was 637.4 days (1-2028 days). Six-year patient survival was 70.5%. Cox's regression analysis determined that independent predictors of worse outcome were as follows: age of the recipient, body mass index of the recipient, previous CVI, preoperative chronic renal insufficiency, pulmonary hypertension, infection in the postoperative course, as well as the need for mechanical circulatory support in the immediate postoperative course. Conclusion: The Serbian Heart Transplantation program demonstrated the survival rate comparable to the HTX centers worldwide and in ISHLT registry. The independent risk factors should be carefully analyzed for our study population and taken into consideration when planning the procedure.

Interhospital Aircraft/Ground Extracorporeal Membrane Oxygenation Transportation by a Mobile Extracorporeal Membrane Oxygenation Team: First Turkish Pediatric Case Series.

Extracorporeal membrane oxygenation is a life-saving treatment for patients with circulatory and respiratory failure refractory to standard therapy. However, safe and timely patient transport to the referral extracorporeal membrane oxygenation center is critical for better patient outcomes in patients with acute cardiogenic shock. This study aimed to describe children's features who were transferred to our center under extracorporeal membrane oxygenation by aircraft/ground vehicle and demonstrated the importance of extracorporeal cardiopulmonary resuscitation for transported children. We report the first Turkish pediatric case series of patients with acute cardiogenic shock transported by aircraft and ground ambulances on extracorporeal membrane oxygenation support to a referral extracorporeal membrane oxygenation center between January 2016 and January 2021. Overall, 6 patients on venoarterial extracorporeal membrane oxygenation support were transported by aircraft and ground vehicles to our pediatric intensive care unit. Transport was achieved by fixed-wing aircraft in 5 patients and commercial aircraft in 1. Our mobile extracorporeal membrane oxygenation team cannulated 3 patients, and 3 patients were cannulated by the team at the hospital they applied to. The median age was 112 (range: 14-204) months and the median weight was 28.6 kg (range: 8.6-57.2 kg). The etiology of acute cardiogenic shock was fulminant myocarditis in 4 patients, dilated cardiomyopathy in 1, and transposition of great arteries and atrial flutter in 1. The median distance of travel for the patients to our hospital was 618 (407-955) km. No adverse events were detected during aircraft or ground vehicle transport. Mobile pediatric extracorporeal membrane oxygenation transport teams may provide safe aircraft and ground vehicle transportation in high-risk patients with acute cardiogenic shock bridging to survival or long-term circulatory support.

German Heart Surgery Report 2021: The Annual Updated Registry of the German Society for Thoracic and Cardiovascular Surgery.

Based on a longtime voluntary registry, founded by the German Society for Thoracic and Cardiovascular Surgery (GSTCVS) in 1980, well-defined data of all cardiac, thoracic and vascular surgery procedures performed in 78 German heart surgery departments during the year 2021 are analyzed. Under more than extraordinary conditions of the further ongoing worldwide coronavirus disease 2019 (COVID-19) pandemic, a total of 161,261 procedures were submitted to the registry. In total, 92,838 of these operations are summarized as heart surgery procedures in a classical sense. The unadjusted in-hospital survival rate for the 27,947 isolated coronary artery bypass grafting procedures (relationship on-/off-pump 3.2:1) was 97.3%. For the 36,714 isolated heart valve procedures (19,242 transcatheter interventions included) it was 96.7 and 99.0% for the registered pacemaker and International Classification of Diseases (ICD) procedures (19,490), respectively. Concerning short- and long-term circulatory support, a total of 3,404 ECLS/ECMO implantations and 750 assist device implantations (L-/ R-/ BVAD, TAH), respectively were registered. In 2021 329 isolated heart transplantations, 254 isolated lung transplantations, and one combined heart-lung transplantations were performed.This annually updated registry of the GSTCVS represents voluntary public reporting by accumulating actual information for nearly all heart surgical procedures in Germany, constitutes advancements in heart medicine and represents a basis for quality management for all participating institutions. In addition, the registry demonstrates that the provision of cardiac surgery in Germany is up to date, appropriate, and nationwide patient treatment is guaranteed all the time.

Lived experiences of patients implanted with left ventricular assist devices

BackgroundBesides survival, improvement in quality of life (QoL) is a major aim of left ventricular assist device (LVAD) implantation. QoL assessment tools in current use are effective in the gathering of standardized metrics but are limited in their ability to elucidate everyday lived patient experiences that also affect overall patient wellbeing. ObjectiveTo describe and understand the lived experiences of patients undergoing long-term circulatory support with LVAD. MethodsA phenomenological approach was used. Purposive sampling of consecutive willing inpatients and outpatients living with an LVAD for longer than 6 months was conducted until theme saturation. There were a total of 21 patients interviewed and this was then recorded and transcribed. ResultsA total of eight themes emerged from the data. Overall, the patients’ quality of life was affected by: (1) whether they had experienced improvements or setbacks in their recent health condition, (2) experiencing burdens from their device such as weight and handling, (3) limitations in their physical ability such as participating in sports, their inability to work; or reduced sleep, (4) reduced social interactions; (5) reduction in sexual activity and performance; (6) experiencing emotional and psychological problems and experiencing anxiety. Patients highlighted the value of obtaining (7) support from family and friends. The interviews also revealed that some patients experienced the feeling of (8) optimism and obtaining “a second chance” at life. ConclusionsLVAD patients have unique concerns and lived experiences. Some themes emerging from this interview series such as having to give up work, having reduced social contact, reduced sexual activity and emotional problems, family support structures demand careful attention during the pre-implantation counselling and post implantation ongoing care. These aspects also deserve more attention in quality of life studies among LVAD patients. Patients with recent improvements in health reported a more positive outlook. Overall the majority of patients reported feeling that they obtained a second chance at life.

Lived Experiences of Patients Implanted with Left Ventricular Assist Devices

<h3>Purpose</h3> Besides survival, improvement in quality of life (QoL) is a major aim of left ventricular assist device (LVAD) implantation. QoL assessment tools in current use are effective in the gathering of standardized metrics but are limited in their ability to elucidate everyday lived patient experiences that also affect overall patient wellbeing. Objective: To describe and understand the lived experiences of patients undergoing long-term circulatory support with LVAD. <h3>Methods</h3> A phenomenological approach was used. Purposive sampling of consecutive willing inpatients and outpatients living with an LVAD for longer than 6 months was conducted until theme saturation. 21 patients were interviewed, and the interviews were recorded and transcribed. Thematic analysis was conducted to characterize how the patients experienced the effects of the implant on their quality of life. <h3>Results</h3> Nine themes emerged from the data. Overall, the patients' quality of life was affected by: (1) whether they had experienced improvements or setbacks in their recent health condition, (2) experiencing burdens from their device such as weight and handling, (3) limitations in their physical ability such as participating in sports, their inability to work; or reduced sleep, (4) reduced social interactions; (5) reduction in sexual activity and performance; (6) experiencing emotional and psychological problems and (7) experiencing anxiety. Patients highlighted the value of obtaining (8) support from family and friends. The interviews also revealed that some patients experienced the feeling of (9) optimism and obtaining "a second chance" at life. <h3>Conclusion</h3> LVAD patients have unique concerns and lived experiences. Some themes emerging from this interview series such as having to give up work, having reduced social contact, reduced sexual activity and emotional problems, family support structures demand careful attention during the pre-implantation counselling and post implantation ongoing care. These aspects also deserve more attention in quality of life studies among LVAD patients. Patients with improvement in recent health condition reported a more positive outlook. Overall the majority of patients reported feeling that they obtained a second chance at life.

German Heart Surgery Report 2020: The Annual Updated Registry of the German Society for Thoracic and Cardiovascular Surgery.

Based on a longtime voluntary registry, founded by the German Society for Thoracic and Cardiovascular Surgery (GSTCVS) in 1980, well-defined data of all cardiac, thoracic and vascular surgery procedures performed in 78 German heart surgery departments during the year 2020 are analyzed. Under the more than extraordinary conditions of the ongoing worldwide coronavirus disease 2019 pandemic, a total of 161,817 procedures were submitted to the registry. A total of 92,809 of these operations are summarized as heart surgery procedures in a classical sense. The unadjusted in-hospital survival rate for the 29,444 isolated coronary artery bypass grafting procedures (relationship on-/off-pump 3.6:1) was 97.2%. For the 35,469 isolated heart valve procedures, (17,471 transcatheter interventions included), the survival rate was 96.7%. Concerning short- and long-term circulatory support, a total of 2,852 extracorporeal life support/extracorporeal membrane oxygenation implantations, respectively, 843 assist device implantations (left/right/biventricular assist device, total artificial device), were registered. In 2020, the number of isolated heart transplantations increased to 340, a rise of 2.1% compared with the previous year. The isolated lung transplantations amounted to 291, a decrease of 6.4%.This annually updated registry of the GSTCVS represents voluntary public reporting by accumulating actual information for nearly all heart surgical procedures in Germany, constitutes advancements in heart medicine, and represents a basis for quality management for all participating institutions. In addition, the registry demonstrates that the provision of cardiac surgery in Germany is up to date, appropriate, and nationwide patient treatment is guaranteed all the time.

5-year results of a newly implemented mechanical circulatory support program for terminal heart failure patients in a Swiss non-cardiac transplant university hospital

BackgroundIn Switzerland, long-term circulatory support programs have been limited to heart transplant centers. In 2014, to improve the management of patients with end-stage heart failure not eligible for transplantation, we implemented a left ventricular assist device (LVAD) program for destination therapy at the University Hospital of Basel.MethodsWe described the program set-up with practical aspects. Patients aged 65 and above with therapy refractory end-stage heart failure without major contraindication for LVAD implantation were included. Younger patients with bridge-to-candidacy profile were also considered. Using the Kaplan-Meier estimate, we retrospectively analyzed the overall survival and freedom from major adverse events after LVAD implantation. We compared our results to internationally reported data.ResultsBetween October 2014 and September 2019, 16 patients received an LVAD in our center. The mean age at implantation was 67.1 years. The mean EuroSCORE II was 24.4% and the median INTERMACS level was 4. Thirteen patients received an LVAD as destination therapy and three patients as bridge-to-candidacy. The overall survival was 87.5 and 70% at 1 and 2 years, respectively. Freedom from stroke was 81.3% at 1 and 2 years. Freedom from device infection was 67.7 and 58.7% at 1 and 2 years, respectively. Freedom from gastrointestinal bleeding was 75 and 56.3% at 1 and 2 years, respectively. Freedom from readmission was 50 and 31.3% and at 6 months and 1 year, respectively.ConclusionsThe Basel experience demonstrated the possible implementation of an LVAD program for destination therapy or bridge-to-candidacy in a non-transplant comprehensive heart-failure center with midterm survival results and freedom from major adverse events comparable to international registries. Patient selection remains crucial.Trial registrationThis study was registered on the ClinicalTrials.gov database (NCT04263012).

Review on Mechanical Support and Cell-Based Therapies for the Prevention and Recovery of the Failed Fontan-Kreutzer Circulation.

Though the current staged surgical strategy for palliation of single ventricle heart disease, culminating in a Fontan circulation, has increased short-term survival, mounting evidence has shown that the single ventricle, especially a morphologic right ventricle (RV), is inadequate for long-term circulatory support. In addition to high rates of ventricular failure, high central venous pressures (CVP) lead to liver fibrosis or cirrhosis, lymphatic dysfunction, kidney failure, and other comorbidities. In this review, we discuss the complications seen with Fontan physiology, including causes of ventricular and multi-organ failure. We then evaluate the clinical use, results, and limitations of long-term mechanical assist devices intended to reduce RV work and high CVP, as well as biological therapies for failed Fontan circulations. Finally, we discuss experimental tissue engineering solutions designed to prevent Fontan circulation failure and evaluate knowledge gaps and needed technology development to realize a more robust single ventricle therapy.

Berlin Heart EXCOR Paediatric Ventricular Assist Device: Does Weight Matter?

Berlin Heart EXCOR (BH) ventricular assist devices provide mechanical long-term circulatory support in children with end-stage heart failure, as a bridge to transplantation or to recovery. Most studies are from large-volume paediatric cardiac centres. The aim of this study was to analyse the experiences of three French centres and to compare these with available published data. We performed a retrospective observational study of three paediatric cardiac intensive care units. All children supported with BH devices were included. Morbidity and mortality data were collected and risk factors analysed. Fifty-four (54) patients (54% male) were included. Survival rate was 73% while on a BH device. Median age at BH device implantation was 17 months (range 2-180 months). The predominant indication was dilated cardiomyopathy (61%). Bi-ventricular assist device was used in 25 (46%) cases. The total length of long-term circulatory support was 3,373 days, with a mean length per patient of 62.5 days (range 5-267 days). Thirty-two (32) patients were transplanted (59%) and seven (13%) were successfully weaned. Type and length of support did not influence morbidity. Main complications were renal dysfunction (57%), bleeding (41%), and infection (39%). In multivariate analysis, a weight <5 kg was significantly associated with higher mortality. The weight seems to be the most important risk factor of mortality in this precarious condition.

German Heart Surgery Report 2019: The Annual Updated Registry of the German Society for Thoracic and Cardiovascular Surgery.

Based on a longtime voluntary registry, founded by the German Society for Thoracic and Cardiovascular Surgery (GSTCVS) in 1980, well-defined data of all cardiac, thoracic, and vascular surgery procedures performed in 78 German heart surgery departments during the year 2019 are analyzed. For this period, a total of 175,705 procedures were submitted to the registry, 100,446 summarized as heart surgery procedures in a classical sense. The unadjusted in-hospital survival rate for the 34,224 isolated coronary artery bypass grafting procedures (relationship on-/off-pump 3.8:1) was 97.3%. For the 36,650 isolated heart valve procedures (16,625 transcatheter interventions included), it was 96.4%. Concerning short- and long-term circulatory support, a total of 2,716 extracorporeal life support/extracorporeal membrane oxygenation implantations, resp. 953 assist device implantations (L-/ R-/ BVAD, TAH) were registered. In 2019, the number of isolated heart transplantations increased to 333, a rise of 6.7% compared to the previous year. The isolated lung transplantations amounted to 311, a decrease of 8.5%. This annually updated registry of the GSTCVS represents voluntary public reporting by accumulating actual information for nearly all heart surgical procedures in Germany, constitutes advancements in heart medicine, and represents a basis for quality management for all participating institutions. In addition, the registry demonstrates that the provision of cardiac surgery in Germany is up to date, appropriate, and nationwide patient treatment is guaranteed all the time.

Muscle-Powered Counterpulsation for Untethered, Non-Blood-Contacting Cardiac Support: A Path to Destination Therapy.

Conventional long-term ventricular assist devices continue to be extremely problematic due to infections caused by percutaneous drivelines and thrombotic events associated with the use of blood-contacting surfaces. Here we describe a muscle-powered cardiac assist device that avoids both these problems by using an internal muscle energy converter to drive a non-blood-contacting extra-aortic balloon pump. The technology was developed previously in this lab and operates by converting the contractile energy of the latissimus dorsi muscle into hydraulic power that can be used, in principle, to drive any blood pump amenable to pulsatile actuation. The two main advantages of this implantable power source are that it 1) significantly reduces infection risk by avoiding a constant skin wound, and 2) improves patient quality-of-life by eliminating all external hardware components. The counterpulsatile balloon pumps, which compress the external surface of the ascending aorta during the diastolic phase of the cardiac cycle, offer another critical advantage in the setting of long-term circulatory support in that they increase cardiac output and improve coronary perfusion without touching the blood. The goal of this work is to combine these two technologies into a single circulatory support system that eliminates driveline complications and avoids surface-mediated thromboembolic events, thereby providing a safe, tether-free means to support the failing heart over extended - or even indefinite - periods of time.

Long-term biventricular circulatory support with POLVAD-MEV paracorporeal pulsatile pumps. Single-centre experience.

IntroductionSevere heart failure decompensation requires circulatory mechanical support in emergency situations. Polish paracorporeal pulsatile pumps, POLVAD-MEV, are designed for biventricular end-stage heart dysfunction.AimTo evaluate long-term POLVAD-MEV therapy by multiple pump exchange in patients on a transplant list.Material and methodsThere were 3 patients in INTERMACS level 1 referred for emergency POLVAD-MED implantation due to acute heart failure deterioration. The paracorporeal pulsatile mechanical support was applied due to severe biventricular dysfunction.ResultsThey were supported by paracorporeal biventricular POLVAD-MEV pumps for 438, 473 and 394 days until heart transplantation. During the hospitalisation the pumps required multiple pumps exchanges within 29 ±10 (4–49) day intervals.ConclusionsPOLVAD-MEV paracorporeal pulsatile pumps present a safe option for long-term circulatory support in a selected group of patients. Therapy requires pump exchange but enables survival while awaiting a heart transplant.

Ventricle-specific epicardial pressures as a means to optimize direct cardiac compression for circulatory support: A pilot study.

Direct cardiac compression (DCC) holds enormous potential as a safe and effective means to treat heart failure patients who require long-term, or even permanent, biventricular support. However, devices developed to date are not tuned to meet the individual compression requirements of the left and right ventricles, which can differ substantially. In this paper, a systematic study examining the relationship, range, and effect of independent pressures on the left and right epicardial surfaces of a passive human heart model was performed as a means to optimize cardiac output via DCC support. Hemodynamic and tissue deformation effects produced by varying epicardial compressions were examined using finite element analysis. Results indicate that 1) designing a direct cardiac compression pump that applies separate pressures to the left and right ventricles is critical to maintain equivalent stroke volume for both ventricles, and 2) left and right ventricular epicardial pressures of 340 mmHg and 44 mmHg, respectively, are required to induce normal ejection fractions in a passive heart. This pilot study provides fundamental insights and guidance towards the design of improved direct cardiac compression devices for long-term circulatory support.

Subxiphoid Exchange of HeartMate II Left Ventricular Assist Device

With increasing use of left ventricular assist devices (LVADs) for long-term circulatory support comes a growing need for device exchange. The conventional surgical approach for device exchanges has been a reoperative median resternotomy. Less-invasive HeartMate II LVAD exchange via a nonmuscle-dividing subxiphoid incision as an alternative to a left subcostal incision may reduce pain burden and facilitate recovery. From November 2006 to June 2015, 292 patients underwent HeartMate II LVAD placement, of which 30 (10.3%) required an exchange. Twenty-four (80%) LVAD exchanges were performed through a subxiphoid sternal-sparing approach and six (20%) through reoperative sternotomy. Predominant indication for device exchange was suspected or confirmed pump thrombus (73.3%), followed by electromechanical pump dysfunction (16.7%). The subxiphoid approach resulted in significantly shorter median intensive care unit (7 vs. 37 days, p = 0.01) and hospital stay (29 vs. 107 days, p = 0.01) compared with reoperative sternotomy. Kaplan-Meier analysis showed comparable survival between the subgroups (p = 0.15) as well as between the patients with device exchange and the rest of the HeartMate II LVAD patients at our institution (p = 0.12). Subxiphoid device exchange is a viable option, resulting in low operative morbidity and mortality with no adverse effect on late survival.

(776) - Outcomes of Heart Transplantation after Long-Term Circulatory Support by Ventricular Assist Devices with Driveline/Pump Infection

(776) - Outcomes of Heart Transplantation after Long-Term Circulatory Support by Ventricular Assist Devices with Driveline/Pump Infection

Comparison of Clinical Outcomes in Patients with INTERMACS Level 1 and 2 Receiving Short-term or Long-term Circulatory Support

Comparison of Clinical Outcomes in Patients with INTERMACS Level 1 and 2 Receiving Short-term or Long-term Circulatory Support

Neuron-specific enolase correlates to laboratory markers of haemolysis in patients on long-term circulatory support.

Neuron-specific enolase (NSE) is used as a diagnostic tool in neuropathies, cerebral diseases or traumata and for some tumours. Furthermore, it is also expressed by erythrocytes and platelets and has been linked to haemolysis ex vivo as a laboratory issue. Chronic haemolysis is frequently associated with mechanical circulatory support by ventricular assist device (VAD) or total artificial heart (TAH). Therefore, we compared NSE with indicators of haemolysis in VAD and TAH patients. We included 599 data sets of 97 patients who underwent VAD or TAH implantation. NSE, haptoglobin (HAPT), haemopexin (HPX), free haemoglobin (frHB), lactate dehydrogenase activity (LDH), platelet counts and total bilirubin (TBIL) in plasma were analysed. Further, all major cerebral events were assessed. NSE correlated to frHB (rs = 0.553) and to LDH (rs = 0.695). An inverse correlation was found with HAPT (rs = -0.484) and HPX (rs = -0.398). Thirty-two patients suffered neurological events. Within the time frame of 1 day before to 4 days after a neurological event, correlations of NSE to HAPT (rs = -0.540) and HPX (rs = -0.611) in negative and to frHB (rs = 0.757), LDH (rs = 0.862) and TBIL (rs = 0.549) in positive direction were established (all P < 0.05). Furthermore, haemolysis was graded into three groups for severe, moderate or no or only slight haemolysis. NSE values differed correspondingly between these groups (P < 0.001). NSE correlates to laboratory parameters indicative of haemolysis in VAD and TAH patients. Our data suggest an influence of intravascular haemolysis on NSE. Therefore, the parameter should be used with caution when it is used to assess cerebral damage.

0056: Results of cardiac transplantation according access modalities. Single centre eight years experience

We evaluated the results of cardiac transplantation according access modalities. Between 2005 and 2012, 562 patients underwent isolated cardiac transplantation, divided into five groups: patients under left ventricular assist device (group LVAD, n=27, 5%), patients under bi-ventricular assist device (group Bi-VAD, n=25, 4%), patients transplanted under ECMO (group ECMO n=90, 16%), patients transplanted according the SuperUrgence1 waiting list without ECMO (group SU1 NOECMO n=131, 23%), patients transplanted on the standard waiting list (group Liste, n=289, 53%). A comparison between the periods 2005/2008 and 2009/2012 was made for the groups LVAD+Bi-VAD, ECMO, SU NOECMO and Liste. The occurrence of primary graft dysfunction was: 26% (group LVAD), 44% (group Bi-VAD), 42% (group ECMO), 21% (group SU1 NOECMO), 26% (group Liste). The period analysis showed no change in primary graft dysfunction over the time: 33% vs 36% (group LVAD+ Bi-VAD), 50% vs. 35% (group ECMO), 23% vs. 20% (group SU1 NOECMO), 28% vs. 24% (group Liste). One-year mortality was: 15% (group LVAD), 20% (group Bi-VAD), 31% (group ECMO), 23% (group SU1 NOECMO), 28% (group Liste). Time analysis showed a 1-year mortality decrease during the 2009/ 2012 period: 10% vs 27% (group LVAD+ Bi-VAD), 29% vs. 33% (group ECMO), 17% vs. 30% (group SU1 NOECMO), 20% vs. 34% (group Liste). Three-year survival was: 81% (group LVAD), 71% (group Bi-VAD), 64% (group ECMO), 74% (group SU1 NOECMO), 66% (group Liste). Actually, stable patients on the standard waiting lists represent only half the transplantation activity. Patients transplanted under longterm circulatory support, especially LVAD, have the best results. Superurgence1 waiting list patients have good results if they not require pre-transplant ECMO support. Need for a pretransplant ECMO is associated with a higher operative mortality. Outcomes improved over the time for every group of patients.