CORRESPONDENCE: LETTER TO THE EDITOR
Impact of Ventricular Assist Device Support on Post-Transplant MortalitySearching for Reasons
Jürgen R. Sindermann, MD*,
Christian Vahlhaus, MD,
Andreas Hoffmeier, MD,
Hans H. Scheld, MD and
Stefan Klotz, MD
* Department of Thoracic and Cardiovascular Surgery, Hospital of the University of Münster, Albert-Schweitzer-Strasse 33, 48149 Münster, Germany (Email: sinderm{at}uni-muenster.de).
Recently, Patlolla et al. (1) reported that ventricular assist devices (VADs) were associated with a significantly increased post-transplant mortality. The authors conclude that VAD implantation is not suitable for the treatment of stable patients awaiting heart transplantation. We would like to congratulate the authors on this study. However, in Germany, within the Eurotransplant International Foundation network (2), the reality of organ shortage and waiting times may lead to other conclusions.
In our center we look back on almost 250 VAD implantations of various intracorporeal and extracorporeal devices since 1993. We share the opinion that VAD implantation is the treatment of choice for patients admitted as an emergency case (3). As a special feature for the Eurotransplant situation, those patients recovering from VAD implantation are only accepted for high urgent status in case they develop serious problems associated with the device. Since the request for organs oversteps the number of organ donors by far, the waiting time for "regular patients" is often more than 2 years, regardless of whether a VAD is present or not. Therefore, in a number of European countries (e.g., Germany) most patients are transplanted in the high urgent status (4), which is currently assigned to more than 80% of all VAD patients in our center. Frankly, this means that a lot of VAD patients have to survive an emergency twice until a suitable organ is offered. This situation is certainly an important reason leading to increased mortality of heart transplantation after VAD implantation. However, a shortage of organs forces physicians to accept the increased risk associated with VADs.
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1. Patlolla V, Patten RD, DeNofrio D, Konstam MA, Krishnamani R. The effect of ventricular assist devices on post-transplant mortality: an analysis of the United Network for Organ Sharing Thoracic Registry J Am Coll Cardiol 2009;53:264-271.[Abstract/Free Full Text]2. Eurotransplant International Foundation http://www.eurotransplant.nl 2009Accessed June 10, 2009. 3. Kamiya H, Koch A, Sack FU, et al. Who needs ‘bridge' to transplantation in the presence of the Eurotransplant high-urgency heart transplantation program? Eur J Cardiothorac Surg 2008;34:1129-1133.[Abstract/Free Full Text] 4. Komoda T, Hetzer R, Lehmkuhl HB. Destiny of candidates for heart transplantation in the Eurotransplant heart allocation system Eur J Cardiothorac Surg 2008;34:301-306.[Abstract/Free Full Text]
Related Article
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- Vishnu Patlolla, Richard D. Patten, David DeNofrio, Marvin A. Konstam, and Rajan Krishnamani
J. Am. Coll. Cardiol. 2009 54: 573.
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