Left ventricular assist device bridge-to-transplant network improves survival after failed cardiotomy

Background. Postcardiotomy cardiogenic shock has been reported to occur following 2% to 6% of cardiac surgical procedures. Both the mandatory New York state cardiac surgery database and a voluntary ventricular assist device registry have reported hospital discharge rates of only 25% in postcardiotomy patients supported with ventricular assist devices. Although many centers have access to short-term mechanical cardiac assist devices, most lack a dedicated team which can resuscitate these critically ill patients. Equally important, these centers do not have easy access to effective cardiac replacement options, including implantable left ventricular assist devices (LVADs) and heart transplantation. Methods. A referral network based upon the use of implantable LVADs as a bridge to transplantation in patients with postcardiotomy heart failure was established in the New York City region. Cardiac surgery centers were encouraged to contact our center early following any failed cardiotomy. Results. Forty-four patients entered our postcardiotomy network: 12 recovered without an implantable LVAD, 23 received implantable LVADs, and six expired without long-term LVAD support. Of the 44 referrals, 29 (66%) survived to hospital discharge. Of the 23 patients receiving implantable LVADs, two recovered myocardial function and underwent LVAD explant, 14 were bridged to heart transplant, one underwent an emergent heart transplant, and six expired. Of the 23 implantable LVAD patients, 17 (74%) survived to hospital discharge. Conclusions. Regional networks centered around bridge-to-transplant facilities that have an aggressive approach to implantable LVAD placement may substantially improve the survival rate of patients with postcardiotomy heart failure. (C) 1999 by The Society of Thoracic Surgeons.