Recovery of end-organ failure during mechanical circulatory support

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Abstract
To evaluate organ recovery during mechanical assistance, respiratory,hepatic and renal function parameters of 40 patients who underwentbridge-to-transplant procedures were reviewed retrospectively. Mechanicalcirculatory support was indicated if the hemodynamic and clinical statusdeteriorated despite pharmacotherapy with catecholamines, vasodilators, andintravenous use of the phosphodiesterase inhibitor enoximone. Sequelae ofcardiogenic shock such as renal, hepatic and respiratory insufficiency werenot considered a contraindication for mechanical support. The analysis ofpreimplant data such as serum creatinine, liver enzymes and pulmonary gasexchange did not identify any predictive indicator of irreversible organdamage. Functional recovery of preexisting respiratory, hepatic and renaldysfunction was found in 91%, 90%, and 85%, respectively. Subsequenttransplantation, however, was affected by the number of failing organsprior to mechanical support. Of 17 patients with isolated organ failureprior to assist, 14 (82%) were transplanted. By contrast, 9 (75%) of 12with combined failure of two organs, and only 6 (54%) of 11 patients withclinical patterns of three failing organ systems received transplants. Inall patients who underwent successful transplantation, transplantabilitywas associated with rapid organ recovery within 10 to 15 days afterinitiating mechanical assistance.

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