Recovery of end-organ failure during mechanical circulatory support

Abstract

To evaluate organ recovery during mechanical assistance, respiratory, hepatic and renal function parameters of 40 patients who underwent bridge-to-transplant procedures were reviewed retrospectively. Mechanical circulatory support was indicated if the hemodynamic and clinical status deteriorated despite pharmacotherapy with catecholamines, vasodilators, and intravenous use of the phosphodiesterase inhibitor enoximone. Sequelae of cardiogenic shock such as renal, hepatic and respiratory insufficiency were not considered a contraindication for mechanical support. The analysis of preimplant data such as serum creatinine, liver enzymes and pulmonary gas exchange did not identify any predictive indicator of irreversible organ damage. Functional recovery of preexisting respiratory, hepatic and renal dysfunction was found in 91%, 90%, and 85%, respectively. Subsequent transplantation, however, was affected by the number of failing organs prior to mechanical support. Of 17 patients with isolated organ failure prior to assist, 14 (82%) were transplanted. By contrast, 9 (75%) of 12 with combined failure of two organs, and only 6 (54%) of 11 patients with clinical patterns of three failing organ systems received transplants. In all patients who underwent successful transplantation, transplantability was associated with rapid organ recovery within 10 to 15 days after initiating mechanical assistance.

The Association of Pretransplant HeartMate II Left Ventricular Assist Device Placement and Heart Transplantation Mortality

“…A few previous reports have shown that patients bridged with VADs typically have improvement in end-organ function after implantation, have lower pulmonary artery pressures, and may be medically more suitable to endure the rigors of the heart transplantation. 16,17 The survival results from this larger patient group seem to be very comparable to the survival results from the most recent studies on continuous-flow device mentioned before. 11,12 When compared with the previous UNOS analysis on pulsatile LVAD, 10 the data have demonstrated a better posttransplantation outcome.…”

The Effect of Ventricular Assist Devices on Post-Transplant Mortality

“…(J Am Coll Cardiol 2009;53:264-71) © 2009 by the American College of Cardiology Foundation Ventricular assist devices (VADs) are increasingly used to successfully bridge patients to heart transplantation. Patients bridged with VADs typically show significant improvement in end-organ function after implantation (1,2). These observations have contributed to the notion that VAD therapy may therefore render patients more medically suitable to endure the rigors of cardiac transplantation.…”

“…Evidence from observational studies suggests that VADs are superior to IABP and inotropic support in successfully bridging patients to transplantation (8,9). VADs have been shown to improve cardiac output and end-organ function (1,2). A study by Deng et al (12) compared mortality by the urgency of placement of a VAD including semielective, urgent, and emergent, and showed that the best outcomes were observed in patients who received VADs semielectively.…”

Left Ventricular Assist Devices and Other Devices for End-Stage Heart Failure: Utility of Echocardiography

“…In the former case, the so-called "bridge-to-recovery" VADs were used to stabilize patients with acute myocarditis, postcardiotomy syndrome, postpartum cardiomyopathy, or massive myocardial infarction [2]. In the latter case, "bridge-to-transplant" VAD implantation demonstrates improved end-organ function [3,4], although recent registry data suggested an increase in short-and long-term post-transplant mortality in patients supported pretransplant with VADs versus those without VAD support [5, 6••]. Patients presenting in acute cardiogenic shock may also receive a VAD as a "bridge to decision," in which VAD implant stabilizes patients while psychosocial and other data are collected to determine eligibility for transplant.…”