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Objective: To evaluate the prognostic influence of peri-implantation nutritional status of patients under mechanical circulatory assist (MCA) prior to cardiac transplantation (CT)., Study Design: Retrospective analysis of patients with cardiogenic shock included from June 1997 to December 2002., Patients and Methods: Evaluation at MCA's implantation, at day (D) 30 and at CT or patient's death (D) of body mass index (BMI=body weight (kg)/size (m(2)), albuminemia (Alb g/l), expressed as median values (med) and range (min-max). Odds ratio (OR) and CI 95%) were calculated. A multivariate analysis was performed to determine variables related to D or CT success., Results: Thirty-four patients (30 men), median age 40.5 years (10-63), were included. MCA types were cardiac pumps (N=3); pneumatic (N=18) or electric (N=5) ventricular assist devices and artificial heart (N=8). Global mortality was 56% (19 over 34 patients) and at implantation in the global population (N=34) BMI was 19.4 (9.3-28.1) and Alb 24.6 g/l (15-37.5). At MCA's implantation and D30 respectively, 38 and 42% of the patients had a severe hypoAlb (Alb<30 g/l) and a BMI<19 attesting of a seriously deteriorated nutritional status. No significant statistical difference was observed on median BMI of transplanted patients T (N=15) and expired patients D (N=19). Alb was significantly different (p<10(-4)) between T and D patients: median Alb: 30 g/l (20-37.5) in T patients, 20 g/l (15-31) in D patients. HypoAlb<21 g/l was an independent prognostic factor of death (p=0.004; OR: 0.541; IC95% : 0.36-0.82) and Alb>33 g/l an independent prognostic factor of CT success (p=0.003; OR:1.38; IC95% : 1.12-1.71)., Conclusion: These results seem to demonstrate that at MCA implantation, a seriously deteriorated albuminemia level (<30 g/l) negatively impacts patients overall survival after CT.

Fifteen patients with acute myocardial infarction and cardiogenic shock underwent emergency cardiac transplantation after medical treatment failed to improve their haemodynamic status. Their mean age was 49 +/- 7 years. The infarction was anterior in 12 cases, inferoposterior in two cases, and septal in one. Shock occurred within 3 days after the onset of chest pain in nine patients, and during the first day in six of them. Mechanical circulatory assistance was used in six patients as a bridge to transplantation when their haemodynamic status could not be stabilized pharmacologically. Orthotopic cardiac transplantation was performed an average of 15.6 +/- 14 days after onset of infarction. Three patients died during the early post-operative period. Another died 7 months after transplantation. During the mean follow-up period of 30.6 +/- 20.3 months, there were three acute rejections, all successfully treated, and one chronic rejection. The survival rate for this series is 70%. Thus, emergency cardiac transplantation may be the best option for selected patients with acute myocardial infarction and cardiogenic shock refractory to conventional therapy.