Mechanical circulatory support and heart transplantation. Pre-operative status and outcome

• Published in: ASAIO journal (1992) Vol. 40; no. 3; p. M476
• Main Authors: Schiessler, A, Friedel, N, Weng, Y, Heinz, U, Hummel, M, Hetzer, R
• Format: Journal Article
• Language: English
• Published: United States 01.07.1994
• Subjects: Adolescent; Adult; Biomedical Engineering; Blood Coagulation; Blood Loss, Surgical; Child; Female; Heart Transplantation; Heart-Assist Devices; Humans; Male; Middle Aged; Platelet Count; Prognosis; Retrospective Studies; Shock, Cardiogenic - blood; Shock, Cardiogenic - surgery; Shock, Cardiogenic - therapy; Time Factors
• ISSN: 1058-2916
• DOI: 10.1097/00002480-199407000-00045

Between July 1988 and December 1993, 118 patients waiting for heart transplantation underwent mechanical circulatory support by an extracorporeal, pneumatically driven assist device (the Berlin Heart System) to maintain a sufficient circulation and to restore impaired organ function (109 patients requiring a biventricular assist device [BVAD], 9 patients requiring a left ventricular assist device [LVAD]). Before implantation, all patients were in severe cardiogenic shock, despite maximum inotropic support; all had end organ failure. The aim of a retrospective study in 70 patients (for whom pre-operative parameters were available) was to identify patients who would permit from this procedure and could undergo successful transplantation. After a mean bridging time of 34.8 days, 75 (63.5%) patients underwent transplant, and 52 (44.1%) were discharged. Pre-operative coagulation parameters (fibrinogen, antithrombin III, platelet count, and kinetics) were correlated to post-operative blood loss and outcome. Patients who had no or mild coagulation disorders because of a shorter phase of low cardiac output before implantation of the assist device proved to gain faster restitution of organ function and most underwent transplantation. As a result of these observations, implantation of an assist device before shock-induced coagulopathy could occur allowed a greater number of patients to undergo successful bridging and be discharged after heart transplantation.