Cardiac transplantation and mechanical circulatory assistance: the Texas Heart Institute experience.

From January 1984 to September 1988, 245 heart transplants were performed at our institution. During this period, 53 staged cardiac transplant procedures were performed using an intraaortic balloon pump (IABP), an extracorporeal centrifugal blood pump (ECBP), an intracorporal left ventricular assist device, and a total artificial heart. Thirty-four (64%) patients underwent subsequent cardiac transplantation and 28 (53%) were discharged. Our data indicate that patients who suffer rapid onset of heart failure and undergo early circulatory support are suitable candidates for successful staged cardiac transplantation. We have also used mechanical support to treat severe heart failure after transplantation, using IABP and ECBP support, as well as an intraarterial axial flow pump. In immunosuppressed patients, infection is the critical issue affecting outcome. There is a need for development of smaller, simpler, less invasive devices with the capacity to provide both systemic and pulmonary circulatory support.