Determinants of operative risk in human heart transplantation

Randall B. Griepp, Edward B. Stinson, Eugene Dong, David A. Clark, Norman E. Shumway

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91 Scopus citations

Abstract

In the past two and a half years twenty-six patients have received heart transplants at Stanford. Over-all survival is 45 per cent at six months, 38 per cent at twelve and eighteen months, and 30 per cent at two years. Analysis of mortality after operation allows separation of these patients into three groups. Three patients died within seventy-two hours of operation, all secondary to markedly elevated pulmonary vascular resistance resulting in progressive right heart failure (group I). Nine patients died in the hospital within two months of operation of infection or rejection (group II). Thirteen patients were discharged in satisfactory condition one to four months after operation (group III). One patient died in the early postoperative period from a cerebrovascular accident apparently unrelated to transplantation. Patients in group I differed significantly from those in groups II and III in having a higher pulmonary artery mean pressure and a higher calculated pulmonary vascular resistance. Patients in group II differed from those in group III with respect to age and the duration of known heart disease. No differences were found between the three groups with respect to number of HL-A antigen mismatches, duration of severe heart disease, cardiac index, mean left atrial pressure, or preoperative bilirubin or blood urea nitrogen levels. Follow-up study of the thirteen patients who survived the immediate postoperative period shows 84 per cent survival at six months, 75 per cent at twelve and eighteen months, and 60 per cent at two years. For patients with end-stage myocardial insufficiency, heart transplantation in appropriately selected cases offers a substantial probability for return to normal activity.

Original languageEnglish
Pages (from-to)192-197
Number of pages6
JournalAmerican Journal of Surgery
Volume122
Issue number2
DOIs
StatePublished - Aug 1971

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