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European Journal of Heart Failure 2007 9(8):845-849; doi:10.1016/j.ejheart.2007.05.002
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© 2007 European Society of Cardiology

Similar transplantation outcomes in patients bridged with cardiac assist devices for acute cardiogenic shock versus chronic heart failure

Stavros G. Drakosa,b, Abdallah G. Kfourya,*, James W. Longa, James C. Stringhamb,c, Edward M. Gilbertb,c, Benjamin D. Hornea, Mary-Beth E. Haganc, Karah Nelsona and Dale G. Renlunda,b

a Utah Transplantation Affiliated Hospitals (U.T.A.H.) Cardiac Transplant Program, LDS Hospital Salt Lake City, Utah, United States
b University of Utah School of Medicine Salt Lake City, Utah, United States
c George E. Wahlen Veterans Affairs Medical Center Salt Lake City, Utah, United States

* Corresponding author. Division of Cardiology, LDS Hospital, 8th Avenue and C Street, Salt Lake City, Utah 84143, United States. Tel.: +1 801 408 5319 E-mail address: akfoury{at}intermountainmail.org.


  Abstract

Background: Heart failure (HF) patients may require cardiac assist device implantation prior to transplantation (Tx) because of either acute cardiogenic shock (ACS), with no prior history of HF, or for progression of pump failure in the setting of chronic HF.

Aims: To investigate whether patients implanted with a cardiac assist device for ACS, have similar post-Tx outcomes as those who underwent cardiac assist device implantation because of progressive chronic HF.

Methods and results: We compared post-Tx outcomes of consecutive patients bridged due to ACS (Acute Group) with the outcomes of patients bridged due to deterioration of chronic HF (Chronic Group). Seventy-three patients had a cardiac assist device implanted and underwent subsequent cardiac Tx. Thirty-five patients (48%) had a cardiac assist device implanted due to ACS, most often caused by massive acute myocardial infarction, and 38 patients (52%) because of progressive chronic HF. Despite greater compromise at the time of implantation, the Acute Group recovered satisfactorily and underwent Tx with similar post-Tx survival rates as the Chronic Group patients [1-year survival: 88.6% vs 86.8%, p=0.80, actuarial survival (mean follow-up 4.2 years): 80.0% vs 81.6%, p=0.86)]. Furthermore, no significant differences were observed between the 2 groups in various post-Tx events.

Conclusion: Patients with ACS who underwent emergency cardiac assist device implantation as bridge to Tx had similar post-Tx outcomes as their more chronically ill counterparts who underwent device implantation on a non-urgent basis.

Key Words: Chronic heart failure • Acute cardiogenic shock • Cardiac assist devices • Heart transplantation

Received December 5, 2006; Revised March 12, 2007; Accepted May 1, 2007


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