Heterotopic heart transplantation: a single-centre experience

Area of Science:

• Cardiovascular Surgery
• Transplantation Medicine
• Cardiac Surgery Outcomes

Background:

• Orthotopic heart transplantation (OHTx) is the standard for end-stage heart disease.
• Heterotopic heart transplantation (HHTx), a parallel graft connection, was historically used before current immunosuppression advancements.
• This study reviews institutional experience with HHTx.

Purpose of the Study:

• To present the authors' experience and outcomes with heterotopic heart transplantation (HHTx).
• To evaluate the feasibility and survival rates of HHTx in specific clinical scenarios.
• To compare HHTx outcomes with established orthotopic heart transplantation (OHTx) data.

Main Methods:

• Retrospective analysis of 12 patients (1.7%) who underwent HHTx between November 1985 and May 2003.
• Patients had dilated or ischemic cardiomyopathy; indications included body size mismatch (11 cases) or marginal organ availability (1 case).
• Associated procedures like left ventricle aneurysm resection were noted.

Main Results:

• Mean ischemic time was 149 minutes; mean cross-clamp time was 82.3 minutes.
• Hospital mortality was 8.3% (one death due to multiorgan failure).
• Actuarial survival rates were 92% at 1 year and 64% at 5 years; causes of death included cancer, liver cirrhosis, aortic dissection, stroke, and chronic rejection.

Conclusions:

• HHTx survival rates are comparable to OHTx, supporting its use with undersized or marginal grafts to expand donor pool.
• Key disadvantages include the necessity for anticoagulant therapy, complex hemodynamic and immunologic monitoring, and the presence of the native diseased heart.
• HHTx remains a valid alternative in select cases, particularly when donor organs are scarce.