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Heart transplantation in patients with diuretic resistant heart failure
F De Vivo1, L S De Santo, C Maiello
1Department of Cardiac Surgery, Second University of Naples, Monaldi, Hospital, Naples, Italy. fabdeviv@tin.it
Insights
Heart transplantation outcomes are similar long-term, regardless of pre-transplant condition. Early survival may vary, but kidney function and urine output improve post-transplant, especially with restored cardiac output.
Area of Science:
- Cardiology
- Transplantation Medicine
- Nephrology
Background:
- Advanced heart failure presents a significant mortality and morbidity challenge.
- Heart transplantation is a primary treatment for selected advanced heart failure patients.
- Pre-transplant clinical status can influence early post-transplant survival.
Purpose of the Study:
- To evaluate the impact of pre-transplant clinical status on heart transplant outcomes.
- To assess early and late survival rates after heart transplantation.
- To examine kidney function recovery and postoperative urinary output in heart transplant recipients.
Main Methods:
- Retrospective analysis of heart transplant recipients.
- Comparison of outcomes based on pre-transplant clinical status.
- Monitoring of cardiac index, kidney function, and urine output post-transplantation.
Main Results:
- Late survival rates after heart transplantation are not affected by initial clinical status.
- Kidney function recovers with restored cardiac output post-transplant.
- Severely ill patients (cardiac index <2.5 l/min/m2) exhibit higher diuretic resistance and mortality.
Conclusions:
- Heart transplantation offers similar long-term benefits irrespective of pre-transplant condition.
- Early post-operative kidney function and urine output are sensitive indicators of recovery.
- Optimizing cardiac output is crucial for improving outcomes in critically ill heart transplant patients.
Abstract:
Advanced heart failure is becoming an increasing cause of mortality and morbidity in a large number of patients. Heart transplantation is the treatment of choice for many selected patients in this group. According to the clinical status at the time of transplant, patients may have a different outcome related to the early survival, while the late results are similar and not affected by the patient's initial clinical status. All surviving patients showed recovery of kidney function as soon the cardiac output was restored to normal values. High urine output was present in a large number of patients in the early postoperative period. However, in severely ill patients with cardiac index <2.5 l/min/m2, diuretic resistance and mortality were higher.