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Heterotopic heart transplantation and recipient heart operation in ischemic heart disease
P D Ridley1, A Khaghani, F Musumeci
1Department of Cardiothoracic Surgery, Harefield Hospital, Middlesex, England.
Insights
Heterotopic heart transplantation combined with recipient heart surgery effectively treats end-stage ischemic heart disease. This approach significantly improves patient survival and functional capacity, offering a viable treatment option.
Area of Science:
- Cardiology
- Transplantation Surgery
- Cardiovascular Research
Background:
- The role of heterotopic heart transplantation in managing coronary heart disease remains undefined.
- End-stage ischemic heart disease presents significant therapeutic challenges.
Purpose of the Study:
- To evaluate the efficacy of heterotopic heart transplantation combined with recipient heart surgery in patients with end-stage ischemic heart disease.
- To assess the impact on patient survival and functional status.
Main Methods:
- A cohort of 28 patients with end-stage ischemic heart disease underwent heterotopic heart transplantation between 1983 and 1988.
- Adjunctive procedures included coronary artery bypass grafts and aneurysmectomy.
- Indications included surgical feasibility and small donor size.
Main Results:
- 1-year and 5-year actuarial survival rates were 79% and 63%, respectively.
- Of 22 patients at 2-year follow-up, 20 improved from New York Heart Association grade III/IV to grades I or II (p < 0.001).
- In 64% of patients, the recipient heart augmented donor cardiac output; in 4, it provided essential support during donor heart failure.
Conclusions:
- Heterotopic heart transplantation combined with recipient heart surgery is an effective strategy for end-stage ischemic heart disease.
- This combined approach enhances cardiac function and improves patient outcomes.
- The recipient heart can play a crucial supportive role in heterotopic transplantation.
Abstract:
The role of heterotopic heart transplantation in coronary heart disease has not been defined. Between 1983 and 1988, 28 patients with end-stage ischemic heart disease were managed by heterotopic heart transplantation and adjunctive operation on the recipient heart: coronary artery bypass grafts and aneurysmectomy, 20; coronary artery bypass grafts, 5; and aneurysmectomy, 3. Indications were feasibility of operative procedures to the recipient heart and small donor size (61% of the donors were less than 15 years). The 1-year and 5-year actuarial survival was 79% and 63%. Of the 22 patients who survived to 2-year follow-up, all of whom had been severely limited (New York Heart Association grade III/IV) preoperatively, 20 were in grades I or II at 2-year follow-up (p less than 0.001). In 14 of 22 patients (64%), the recipient heart augmented the donor cardiac output substantially, and in 4 the recipient heart supported the patient when the donor heart failed to eject. In conclusion, this series demonstrates the efficacy of heterotopic transplantation combined with operation to the recipient heart in the management of patients with end-stage ischemic heart disease.