VAD as a bridge-to-transplant: Long-term results of patients with ischemic cardiomyopathy

Objectives: We compared long-term results of patients with ischemic cardiomyopathy who underwent either HTx alone or HTx with prior VAD-implantation in a 2-years period. Material and Methods: Between 01.01.1995 and 31.12.1996 76 patients with ICM underwent HTx in our institution. 19 patients (VAD group) underwent prior VAD-implantation (15 LVAD/4 BVAD) with a mean support time of 95 days (12–233). 7 were operated in cardiogenic shock and 11 were in multiple-organ-failure at the time of implantation. We recorded data at the time of HTx and compared perioperative mortality and long-term results (mean follow-up 86 months). Results: On the day of HTx mean age in the VAD group was 53.8 (30–68) years (89% male) and in non-VAD group 58.6 (45–77) years (91% male). All patients in VAD group and 30 (52.6%) in non-VAD group underwent previous cardiac surgery. 3 (15.8%) patients in VAD group and 15 (26.3%) in non-VAD group suffered from renal failure. 2 patients (10.5%) in the VAD and 9 patients (15.8%) in non-VAD group died perioperatively. Late mortality was 3 (15.8%) in the VAD and 12 (21.1%) in the non-VAD group, respectively. Survival at 1, 5, 7 years postoperatively was 89, 74, 74% in the VAD and 75, 66 and 63% in non-VAD group. Conclusions: Patients in VAD group are significantly younger and the number of non-cardiac organ dysfunction is lower than in non-VAD group. Early and late mortality are lower in VAD group. Regression of non-cardiac organ dysfunctions and an improved physical status facilitated by VAD support lead to improved results after HTx.