ORIGINAL ARTICLES  CARDIAC PAPERS 

The Journal of Cardiovascular Surgery 2000 October;41(5):691-4

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: English

Implantation of the Biomedicus centrifugal pump in post-transplant right heart failure

Reiß N., El-Banayosy A., Mirow N., Minami K., Körfer R.

From the Clinic for Thoracic and Cardiovascular Surgery Heart Center North Rhine-Westphalia Bad Oeynhausen, Germany

Background. Right ­heart fail­ure ­after ­heart trans­plan­ta­tion rep­re­sents a ­life-threat­en­ing com­pli­ca­tion. When con­ven­tion­al ther­a­py includ­ing NO-inha­la­tion ­fails the ­only ­choice to ­reach suf­fi­cient hae­mod­y­nam­ic con­di­tions may be the implan­ta­tion of a ­right ven­tric­u­lar sup­port ­system.
Methods. In all cas­es the Biomedicus cen­trif­u­gal ­pump was implant­ed by can­nu­la­tion of the ­right atri­um and pul­mo­nary ­artery.
Results. Since March 1989 950 ­heart trans­plant pro­ce­dures ­were per­formed at our cen­ter. In ­nine cas­es (7 ­male, 2 ­female, ­mean age 52 ­years) implan­ta­tion of a ­right ven­tric­u­lar sup­port ­system was nec­es­sary ­because of dete­ri­ora­tion of ­right ven­tric­u­lar func­tion. The implan­ta­tion was car­ried out in 7 cas­es imme­di­ate­ly ­after trans­plan­ta­tion, in 2 cas­es ­after 2 ­days. The sup­port ­time ­ranged ­from 4-348 ­hours. Six ­patients ­could be ­weaned, 2 ­patients under­went retrans­plan­ta­tion and ­died and 1 ­patient ­died on the sup­port ­system. Three of the six ­weaned ­patients ­died in the fur­ther ­course ­because of mul­ti­or­gan fail­ure.
Conclusions. Mechanical ­right ven­tric­u­lar sup­port is ­often the ­only ther­a­peu­ti­cal ­tool to ­reach ade­quate hae­mod­y­nam­ic con­di­tions in ­post-trans­plant ­right ­heart fail­ure. The Biomedicus cen­trif­u­gal ­pump pro­vides ­good con­di­tions in ­these cas­es. Weaning is ­often pos­sible ­after ­short-­term sup­port. The mor­tal­ity ­rate is deter­mined by mul­ti­or­gan fail­ure in immu­no-­sup­pressed ­patients. Retransplantation ­seems not to be suc­cess­ful ­despite max­i­mal treat­ment.