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J Thorac Cardiovasc Surg 2003;126:442-447
© 2003 The American Association for Thoracic Surgery

Cardiopulmonary support and physiology

BVS5000 support after cardiac transplantation

^a Division of Cardiothoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC, USA,
^b Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC, USA

Received for publication May 22, 2002. Received for publication May 22, 2002; revisions received July 30, 2002; revisions received August 16, 2002; accepted for publication September 23, 2002.

^* Address for reprints: Carmelo A. Milano, MD, Assistant Professor of Surgery, Department of Surgery, The Duke University Medical Center, Box 3043, Durham, NC 27703, USA
milan002{at}mc.duke.edu

OBJECTIVE: This study examines short-term mechanical assist device support for cardiac transplant patients and compares their outcomes with nontransplant patients requiring similar support.

METHODS: Of 350 cardiac transplant patients at our institution, 7 patients required mechanical ventricular assistance with the Abiomed BVS5000 assist device (Abiomed, Inc, Danvers, Mass) after transplant secondary to severe acute rejection with cardiogenic shock (n = 4) or primary graft failure (n = 3). Recovery of ventricular function, survival to discharge, and complications were determined for the transplant group and compared with a second group comprising all other patients supported with the BVS5000 at our institution (n = 15). Additionally, the results of prior series reporting mechanical ventricular support of the failing transplant heart are reviewed.

RESULTS: Demographics and duration of support were similar between the groups. The transplant group had a higher wean rate from device relative to the nontransplant group (100% versus 13%; P < 0.01). Five of 7 in the transplant group achieved survival to discharge (71%), relative to 5 of 15 in the nontransplant group (33%). Complications between the two groups were similar, although the transplant group experienced a higher rate of renal insufficiency (57% versus 13%, P = 0.05).

CONCLUSION: Severe acute rejection with cardiogenic shock and primary graft failure are two conditions that may warrant mechanical ventricular support in the cardiac transplant patient. Transplant patients with these conditions have a high rate of ventricular functional recovery, greater than nontransplant patients supported with the same device and for a similar period of time. Although the incidence of renal insufficiency was higher, the majority of transplant patients who were supported with the BVS5000 achieved survival to discharge.

Key Words: 27 • 34