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THE JOURNAL OF CARDIOVASCULAR SURGERY

Rivista di Chirurgia Cardiaca, Vascolare e Toracica


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The Journal of Cardiovascular Surgery 2015 June;56(3):493-502

Copyright © 2015 EDIZIONI MINERVA MEDICA

lingua: Inglese

Bridge to transplantation using paracorporeal biventricular assist devices or the syncardia temporary total artificial heart: is there a difference?

Nguyen A. 1, Pozzi M. 1, 3, Mastroianni C. 1, Léger P. 2, Loisance D. 1, Pavie A. 1, Leprince P. 1, Kirsch M. 1

1 Department of Cardiothoracic Surgery, La Pitié‑Salpêtrière Hospital, Université Pierre et Marie Curie, Paris VI, Groupe Hospitalier Pitié‑Salpêtrière, Paris, France; 2 Department of Anesthesiology, La Pitié‑Salpêtrière Hospital, Université Pierre et Marie Curie, Paris VI, Groupe Hospitalier Pitié‑Salpêtrière, Paris, France; 3 School of Cardiovascular Science, Unit of Cardiovascular Surgery, University of Verona, Verona, Italy


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AIM: Biventricular support can be achieved using paracorporeal ventricular assist devices (p-BiVAD) or the Syncardia temporary total artificial heart (t-TAH). The purpose of the present study was to compare survival and morbidity between these devices.
METHODS: Data from 2 French neighboring hospitals were reviewed. Between 1996 and 2009, 148 patients (67 p-BiVADs and 81 t-TAH) underwent primary, planned biventricular support. There were 128 (86%) males aged 44±13 years.
RESULTS: Preoperatively, p-BiVAD recipients had significantly lower systolic and diastolic blood pressures, more severe hepatic cytolysis and higher white blood cell counts than t-TAH recipients. In contrast, t-TAH patients had significantly higher rates of pre-implant ECLS and hemofiltration. Mean support duration was 79±100 days for the p-BiVAD group and 71±92 for t-TAH group (P=0.6). Forty two (63%) p-BiVAD recipients were bridged to transplantation (39, 58%) or recovery (3, 5%), whereas 51 (63%) patients underwent transplantation in the t-TAH group. Death on support was similar between groups (p-BiVAD, 26 (39%); t-TAH, 30 (37%); P=0.87). Survival while on device was not significantly different between patient groups and multivariate analysis showed that only preimplant diastolic blood pressure and alanine amino-transferase levels were significant predictors of death. Post-transplant survival in the p-BiVAD group was 76±7%, 70±8%, and 58±9% at 1, 3, and 5 years after transplantation, respectively, and was similar to that of the t-TAH group (77±6%, 72±6%, and 70±7%, P=0.60).
CONCLUSION: Survival while on support and up to 5 years after heart transplantation was not significantly different in patients supported by p-BiVADs or t-TAH. Multivariate analysis revealed that survival while on transplantation was not affected by the type of device implanted.

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Per citare questo articolo

Nguyen A, Pozzi M, Mastroianni C, Léger P, Loisance D, Pavie A, et al. Bridge to transplantation using paracorporeal biventricular assist devices or the syncardia temporary total artificial heart: is there a difference? J Cardiovasc Surg 2015 June;56(3):493-502. 

Corresponding author e-mail

matthias.kirsch@psl.aphp.fr