Bridge-to-transplant given good marks.

Bridge-to-transplant given good marks

With thousands of heart transplants now being performed worldwide, medical personnel in a hospital's cardiac unit frequently find themselves buying time while searching for an appropriate donor heart for transplant. Because the hours and days often needed to locate a well-matched heart can literally mean the difference between life and death, researchers have been studying artificial hearts as potential bridge-to-transplant devices -- keeping patients alive until donor hearts arrive. The bridge-to-transplant concept has had its controversies and problems, as the target of criticism that the mechanical devices lead hospitals to waste scarce donor hearts on patients too sick to benefit from transplantation (SN: 1/4/86, p.4). Those concerns may be misplaced, according to a new study.

After using mechanical devices to pump blood in 21 patients who later received a donor heart, researchers at several medical centers in the United States conclude in the Feb. 11 NEW ENGLAND JOURNAL OF MEDICINE that such "bridges" are both safe and effective. Led by David J. Farrar and J. Donald Hill of Pacific Presbyterian Medical Center in san Francisco, the researchers say that, at the time of the report, 19 of the 21 heart recipients were still alive seven to 39 months after their transplant. Eleven of the original 12 had survived at least one year. Thus far, say the authors, these survival rates are comparable to or better than those seen in transplant patients not receiving the so-called ventricular assist device. One risk anticipated by the scientists -- that of serious infection due to inserted tubing -- was not a life-threatening problem with the device used, although patients were on support from eight hours to 31 days before transplant, Hill told SCIENCE NEWS. He says more recent data continue to support observations that more than 80 percent of bridge-to-transplant patients should survive a year and longer. Since the current report was compiled, a total of 57 patients have been put on the pump, with 46 eventually receiving hearts.

The authors caution that the decision to use assist devices be made carefully, however. At an average age of 36, the patients were relatively young and considered healthy enough to withstand necessary surgery. In addition to the 21 patients in the study given hearts, eight others placed on the pump had not been stable enough to receive a heart and later did.