Bridge to transplant experience: Factors influencing survival to and after cardiac transplant

Abstract

Initiating mechanical circulatory support early with a single definitive device may improve survival to and after cardiac transplantation. Early transplant, which avoids infection, sensitization, and neurologic complications, may improve bridge and transplant survival.

Survival after biventricular mechanical circulatory support: Does the type of device matter?

“…Others have suggested that reduced post-transplant survival might be related to increased allosensitization acquired during MCS that could be associated with an increased risk of rejection and the need for increased immunosuppression. 21,22 Our data suggest that there might be an optimal time window for transplantation of patients under MCS, during which patient recovery is optimal and the previously mentioned risks related to prolonged support, are still relatively low.…”

“…Smedira et al, 21 however, showed that longer duration of support might adversely affect post-transplant survival. In patients undergoing long-term support, device-related adhesions may represent a considerable challenge upon resternotomy, increasing the risk of tissue injury and damage to the mechanical device, the length of the procedure, and the risk of bleeding and need for blood product transfusion.…”

Results of mechanical circulatory support in France

“…5, the incidence of death is the lowest between 3 and 6 months, while beyond this time period, the risk of mortality increases, which may be accounted for by the occurrence of standard complications such as device infection, hemorrhagic or thromboembolic complications, and device dysfunction. A circulatory assistance period of long duration while waiting for heart transplantation may also be a risk factor for mortality following heart transplantation [19]. In France, since 2005, priority for heart transplantation was given to patients in advanced heart failure or 'moderate' cardiogenic shock, patients under extracorporeal life support, and those under MCS with device infection or neurological complication.…”

SynCardia Temporary Total Artificial Heart as Bridge to Transplantation: Current Results at La Pitié Hospital

“…Since 2004, the most critical candidates were stabilized using extracorporeal life support in a bridge to bridge strategy. Although such a staged bridge to bridge strategy exposes patients to 2 successive surgical procedures and has been associated with adverse outcome [13], it provides time for patient selection and avoids implantation of costly devices in moribund patients. Of importance, pre-implant ECLS support was not identified as an independent risk factor for death after TAH implantation.…”