Medium term results of heterotopic heart transplantation

R. Bleasdale, N. R. Banner, A. Anyanwu, A. Khaghani, A. Mitchell, M. H. Yacoub

Research output: Contribution to journalArticlepeer-review

Abstract

Orthotopic cardiac transplantation is an established treatment for advanced heart failure but its application is limited by the scarcity of donor organs. Heterotopic transplantationis an alternative, which may reduce the need for donor-recipient size matching (and so facilitate the use of smaller donor organs). It can also be used to treat patients with pulmonary hypertension due to left ventricular (LV) failure . We analysed the outcome at our Centre between January 1993 and January 1999 (288 orthotopic transplants were performed in the same period) The mean age of those receiving heterotopic transplants was 51 years (range 29-69) and 33 (79%) were male. Twenty-six had heart failure due to ischaemic heart disease and 16 had dilated cardiomyopathy. The indication for heterotopic transplantation was urgency in 15 cases and pulmonary hypertension due to LV failure in 21. In 9 cases there was a major donor-recipient size mismatch and in 8 the native heart underwent surgical repair (CABG/valve surgery/myomectomy). The acturial survival (compared to the orthotopic group) was 64% (vs. 77%) at 1 year 61% (vs. 74%) at 3 years and 40% at five years (vs. 67% at our Centre and 65% in the International Society for Heart and Lung Transplantation Registry) (p=0.012). Four died from primary graft failure and 4 from acute rejection. Five patients (12%) experienced systemic embolic events (3 fatal) while not on warfarin. Twenty-three(55%) were anticoagulated because of native LV clot seen on echo (10), native atrial arrhythmia (6), severe native LV dilatation (5) and embolic events (2). Ther were 2 fatal cerebral bleeds in the patients on warfarin. Four patients had recurrent angina, 13 had native ventricular arrhythmia and 15 native artial arrhythmia (cardioversion was required on 24 occasions The early outcome of heterotopic transplantation, in this high risk population, was similar to that of orthotopic transplantation but many patients experienceed late complications related to the native heart.

Original languageEnglish
Pages (from-to)P35
JournalHeart
Volume83
Issue numberSUPPL. 1
StatePublished - May 2000
Externally publishedYes

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