Related Experiment Videos
Cardiac transplantation at the Cleveland Clinic Foundation
K Hoercher1, P McCarthy, J B Young
1Kaufman Center for Heart Failure, Cleveland Clinic Foundation, Ohio, USA.
Insights
Heart transplant programs have evolved patient selection and donor criteria, enabling the transplantation of sicker patients. Despite these challenges, outcomes remain exemplary, demonstrating program success.
Area of Science:
- Cardiology
- Transplantation Medicine
- Surgical Outcomes
Background:
- Significant evolution in heart transplant protocols over 15 years.
- Broadened donor suitability and acceptance of sicker, hemodynamically unstable recipients.
- Cleveland Clinic Foundation's experience with advanced heart transplantation.
Purpose of the Study:
- To review advancements in heart transplant patient selection and donor criteria.
- To evaluate the outcomes of heart transplantation at the Cleveland Clinic Foundation.
- To identify key factors contributing to successful heart transplant programs.
Main Methods:
- Retrospective analysis of 265 heart transplants performed between 1996-1998.
- Review of evolving patient selection criteria and donor definitions.
- Assessment of immunosuppressive strategies, infection prophylaxis, and post-transplant surveillance.
Main Results:
- One-year survival rate of 88% and 3-year survival rate of 81% for the cohort.
- Successful transplantation of increasingly ill and hemodynamically unstable patients.
- Exemplary outcomes achieved despite expanding selection criteria.
Conclusions:
- Advancements in heart transplant criteria have enabled the treatment of more complex patients.
- Program success is attributed to interdisciplinary collaboration, expert support, and dedication to excellence.
- Continuous investigation of clinical challenges is vital for improving heart transplant outcomes.
Abstract:
The past 15 years has seen a significant evolution of heart transplant patient selection criteria, definition of suitable donors, immunosuppressive strategies, infection prophylaxis and treatment, and post-transplant patient surveillance. Primarily important has been broadening of the donor suitability definition and an evolution toward transplanting more ill and hemodynamically unstable patients. Despite "pushing the envelope" with both patient and donor selection and with transplanted patients generally being more ill, we believe our outcomes at the Cleveland Clinic Foundation are exemplary. The one- and 3-year survival rates for 265 heart transplants performed during 1996-1998 were 88% and 81%, respectively. Key to the success of our program has been close interdisciplinary working relationships and respect, broad and expert consultative support services, a desire to investigate clinical challenges, and dedication to excellence. Of additional importance is the realization that no matter how difficult we believe our difficulties are, we realize that those of our patients are vastly greater.