| Abstract
| - To distinguish high-risk patients prior to implantation of a Jarvik-7artificial heart as a bridge to transplantation, our 37 attempts werereviewed retrospectively. Arbitrary scores of 1 to 4 were given for ninepreoperative factors on the basis of results obtained by uni- andmultivariate analyses between successful cases and failed attempts;transplant rejection (scored 4: S4) or postoperative heart failure (S3) asthe indication, recipient height less than 175 cm (S3), body surface arealess than 1.8 m2 (S3), hyperbilirubinemia greater than 24 microM/l (S2),preoperative renal failure requiring dialysis (S2), weight less than 60 kg(S2), and age greater than 40 years (S1). All except one of the 16 patientswith successful bridge had a total score of less than 4, with an averagescore of 1.3 in contrast to 6.6 in the 21 failed cases (p less than 0.001).Among the 17 patients who scored less than 4, 15 received transplants(specificity 90%), while only one qualified for transplantation among 20patients who scored 4 or more (sensitivity 94%). The two unpredictedfailures resulted from mediastinitis and pulmonary infarction, bothattributable to postoperative management. Multiple preoperative factors incombination could have successfully predicted the outcome of mechanicalsupport in our experience. These results underscore the importance ofpatient selection to achieve successful and effective use of the Jarvik-7as a bridge to heart transplantation.
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