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Outcome of patients listed for heart transplantation after a failed surgical ventricular restoration procedure

M Triggiani1, A Iacovoni, R Fiocchi

  • 1Cardiac Surgery Unit, Ospedali Riuniti di Bergamo, Bergamo, Italy. mtriggiani@ospedaliriuniti.bergamo.it

Transplantation Proceedings
|August 5, 2008
PubMed

Insights

Heart transplantation after failed surgical ventricular restoration (SVR) in ischemic cardiomyopathy patients shows comparable outcomes to re-transplantation after coronary artery bypass grafting. While list mortality is high, SVR failure does not appear to significantly increase heart transplant mortality risk.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Transplantation Medicine

Background:

  • End-stage ischemic cardiomyopathy with left ventricular dilatation is often treated with surgical ventricular restoration (SVR).
  • SVR can serve as a bridge to heart transplantation (HTX), potentially delaying the need for HTX.
  • The outcomes of HTX following a failed SVR (fSVR) require careful evaluation.

Purpose of the Study:

  • To retrospectively analyze the outcomes of heart transplantation (HTX) in patients with ischemic cardiomyopathy (IHD).
  • To compare the mortality risk of HTX after failed surgical ventricular restoration (fSVR) versus HTX after conventional coronary artery bypass grafting (CABG).

Main Methods:

  • Retrospective analysis of 133 patients with IHD listed for HTX since June 1999.
  • Patients were categorized into three groups: no redo (n=54), redo after CABG (n=54), and redo after fSVR (n=25).
  • In-hospital and on-list mortality rates were compared across the groups.

Main Results:

  • In-hospital mortality after HTX was 10.8% for non-redo, 36.4% for post-CABG redo, and 16.7% for post-fSVR redo.
  • On-list mortality was 16.7% for non-redo, 20.4% for post-CABG redo, and 28.0% for post-fSVR redo.
  • Patients undergoing HTX after fSVR experienced complications including acute renal failure and acute rejection, with mortality attributed to multisystem organ failure.

Conclusions:

  • Patients listed for heart transplantation exhibit high on-list mortality.
  • Heart transplantation after failed surgical ventricular restoration does not appear to carry a significantly poorer outcome compared to heart transplantation after previous conventional coronary artery bypass grafting.
  • Further investigation is needed to identify optimal patient selection criteria for SVR in the context of potential future HTX.

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