Selection of Candidates for Circulatory Support Devices as a Bridge to Heart Transplantation

(Division of Cardiovascular Surgery, Kyushu University, Fukuoka, Japan and Department of Cardiovascular Surgery, Kumamoto City Hospital, Kumamoto, Japan)

Ken-ichi Imasaka* Yasuhisa Oishi Toshiro Iwai
Noriyoshi Kajihara Munetaka Masuda Hisataka Yasui
Circulatory support devices have become an important component for transplantation programs as they successfully bridge unsalvageable patients who would otherwise die. Between October 1997 and April 2001, 6 patients in profound heart failure were treated with a percutaneous cardiopulmonary support system (PCPS), or with ventricular assist device (VAD), or with both PCPS and VAD. Two patients were treated only with a PCPS, and one weaned case survived. Another 2 patients, who had dilated cardiomyopathy, was treated with VAD. They improved hemodynamically, and their general conditions made them fit to be candidates for heart transplantation. Two other patients who had PCPS insertion before VAD died due to multiple organ failure. Before the application of VAD, the levels of total bilirubin were 14.9 and 20.9mg/dl respectively. In acute worsening of hemodynamics, PCPS is useful to maintain total circulation by quick application. However, long-term support with VAD should be considered to resuscitate impaired end-organ function by carefully selecting the timing of a VAD implantation.
@Jpn. J. Cardiovasc. Surg. 34: 243-247 (2005)