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  • Title: Importance of preoperative liver function as a predictor of survival in patients supported with Thoratec ventricular assist devices as a bridge to transplantation.
    Author: Reinhartz O, Farrar DJ, Hershon JH, Avery GJ, Haeusslein EA, Hill JD.
    Journal: J Thorac Cardiovasc Surg; 1998 Oct; 116(4):633-40. PubMed ID: 9766593.
    Abstract:
    UNLABELLED: Patient selection is crucial for the success of ventricular assist devices as a bridge to heart transplantation. PURPOSE: The objective of this study was to identify preoperative markers for survival and end-organ recovery in patients having a ventricular assist device. METHODS: A retrospective study was performed on 32 severely ill patients with end-stage cardiac failure being mechanically bridged to heart transplantation with the Thoratec Ventricular Assist Device System (Thoratec Laboratories Corporation, Pleasanton, Calif) in a single center between 1984 and 1995. The preoperative cardiac index averaged 1.6 L/min per square meter with a pulmonary capillary wedge pressure of 29 mm Hg. Because of a high incidence of hepatic or renal dysfunction, or both (total bilirubin: 3.5 +/- 6.2 mg/dL; creatinine: 2.0 +/- 1.3 mg/dL), biventricular support was used in most patients (28/32). A total of 30 preoperative and 4 perioperative variables were evaluated for their association with survival and liver recovery. RESULTS: Nineteen patients (59.4%) survived to transplantation and 13 died. All 19 patients undergoing transplantation were discharged alive with a 1-year survival of 94.4%. All patients without liver recovery died of multiorgan failure. Direct and indirect bilirubin measurements were the only significant predictors for survival to discharge (P = .036, .045); all other factors failed to show significance. As direct bilirubin levels increased (normal range, 3 times normal, and >3 times normal), patient survival decreased (82 %, 56%, and 33 %, respectively). In addition, bilirubin and liver enzyme levels before insertion of the assist device were significantly associated with liver recovery during support with the device. CONCLUSION: In our patient population with ventricular assist devices, liver function is the most predictive factor of patient survival in bridging to transplantation.
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