Optimal utilization of mechanical circulatory support and transplant resources in the comprehensive treatment of terminal heart failure

In the adult group, 66% of patients were at INTERMACS level 1, critical cardiogenic shock, and 19% were at level 2, progressive decline. Indications for primary MCS included: acute exacerbation of chronic heart failure, acute cardiogenic shock and respiratory failure. Altogether, procedural success was accomplished in 49.4% of patients. MCS efficiently bridged 14 patients with heart failure to heart transplantation. In 15 patients, long term support was instituted, either as a destination therapy or as a bridge to heart transplant; 13 received HeartMate II, and 2 patients received HeartWare. One patient with respiratory failure was successfully bridged to lung transplantation. In the pediatric group, 60% patients were bridged to recovery. Postcardiotomy MCS was used in 33.7% patients. Patient outcome after 30 days was assessed as: alive (22.4%), alive on support (13.5%), dead (64.0%). The most common perioperative complication was renal failure, in 42.7% patients.