Cardiac transplantation is a safe and predictable therapeutic option whose
major limits lie in the scarsity of available organs. In the indicated
patients, who are found to have hemodynamic deterioration is uncontrollable
with medical therapy and thus a life expectancy of few days, using
an “artificial heart” can allow survival until such time as a donor
heart is made available. Circulation-assist system consist in one or two
pumps that work in parallel with the native heart. the choice between mono-
or biventricular assistance depends on the patient's hemodynamic characteristics.
A left ventricular-assistance device (LVAD) alone is contraindicated in
the presence of high pulmonary vascular resistance: in this event the employment
of a biventricular assistance device (BVAD) is necessary.
Between March 1988 and October 1998, at the “Angelo De Gasperis” Cardiosurgery
Division in Milan's Niguarda Hospital, 39 mechanical ventricular
assistance devices were fitted as a “bridge” to cardiac transplantation:
36 males and 3 females with an age range from 16 to 63 years. In one patient
a left monoventricular assist was applied as a permanent system due to
the concomitant presence of conditions that contraindicated cardiac transplantation.
ten patients (25.6%) died during the assistance period. Twenty-seven (69%)
underwent the transplants. Twenty-one transplanted patients (78%) were
discharged from hospital and twenty (74%) are alive at 5 to 124 months
(mean 51.7) post-op. Two patients are still on VAD (1 permanently).
The ventricular-assist systems are therefore a valid and efficacious
therapeutic measure that allows the survival of patients who are in conditions
so grave as would rapidly lead to death in 100% of cases, prejudicing their
transplantability. Furthermore, in our experience and that of others, circulation
assistance does not influence the outcomes over time of the cardiac transplantations
in terms of survival rates, rejections and/or the development of grafted-heart
coronaropathies.