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DOI: 10.1055/s-0040-1705495
Bridging Patients in Cardiogenic Shock with the Berlin Heart Excor Biventricular Assist Device to Heart Transplantation: A Single-Center Experience
Publication History
Publication Date:
13 February 2020 (online)
Objectives: Mechanical circulatory support (MCS) is an established therapy for advanced heart failure. We evaluated the outcome of patients receiving MCS with the Berlin Heart Excor biventricular assist device (BVAD) in (beginning) cardiogenic shock (INTERMACS levels 1 and 2) as a bridge to transplantation.
Methods: Between 2004 and 2019, a total of 95 patients received a Berlin Heart Excor BVAD at our institution. All patients were in INTERMACS level 1 (n = 82, 86.31%) or 2 (n = 13, 13.68%). 75 patients were male (78.94%). 7 patients were younger than 18 years (7.36%). Mean age at implantation was 43.86 years (1–66). 59 patients (62.10%) were already on MCS (IABP, n = 31; ECLS, n = 20; IABP + ECLS, n = 5; Impella, n = 2; ECLS + Impella, n = 1) before BVAD implantation.
Primary diagnoses were dilated cardiomyopathy (n = 41), ischemic cardiomyopathy (n = 17) or myocardial infarction (n = 4), myocarditis (n = 15), restrictive CMP (n = 2), graft failure after heart transplant (n = 7), congenital heart disease (n = 1), postpartum CMP (n = 3), and postcardiotomy heart failure (n = 5). Preoperative data were as follows: LVEF 16.28% ± 8.03, bilirubin 3.64 mg/dL ± 4.28, and creatinine 1.79 mg/dL ± 0.76.
Results: Mean duration of support was 58 days (0–477 days). Cerebral stroke occurred in 16 patients, bleeding in 10, and infection in 13 patients.
Forty-seven patients (49.47%) died on support, while 48 patients (51%) could be successfully bridged to transplantation. 30-day and 1-year survival rates were 69.47 and 38.95%, respectively. Main causes of death after BVAD implantation were multiorgan failure (n = 24), intracerebral bleeding (n = 10), sepsis (n = 8), stroke (n = 3), pulmonary embolism (n = 1), intestinal bleeding (n = 1).
Conclusion: The implantation of a Berlin Heart Excor BVAD as a bridge to transplantation offers a reasonable therapeutic option for patients with beginning cardiogenic shock, when immediate high cardiac output is necessary to rescue the already impaired kidney and liver function of the patient.