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Cardiac transplantation: treatment for cardiogenic shock
S J Jackson1, A R Dobell, N Poirier
1Cardiovascular Research Unit, Royal Victoria Hospital, Montreal, Que.
Insights
Orthotopic cardiac transplants show promising survival rates, with most patients alive and well post-surgery. This study highlights the success of heart transplantation in improving patient outcomes and return to daily life.
Area of Science:
- Cardiology
- Transplantation Surgery
Background:
- Orthotopic cardiac transplantation is a critical intervention for end-stage heart failure.
- Between 1985 and 1989, 86 patients underwent orthotopic cardiac transplants at the Royal Victoria Hospital.
Observation:
- A subset of 16 patients were critically ill, requiring mechanical circulatory support (inotropic agents or intra-aortic balloon pump).
- The study compared outcomes between critically ill and elective transplant recipients.
Findings:
- The early death rate was 6.3% for the entire cohort, with one early death occurring at 7 days.
- Delayed infections led to two late deaths (viral hepatitis and Pneumocystis pneumonia).
- Of the 16 critically ill patients, 13 (81%) survived long-term, with 9 returning to work and others functioning well.
Implications:
- Orthotopic cardiac transplantation can be successful even in critically ill patients.
- The procedure offers significant long-term survival and functional recovery, improving quality of life.
- These findings support the expansion of heart transplantation criteria to include sicker patients.
Abstract:
Eighty-six patients received orthotopic cardiac transplants at the Royal Victoria Hospital in Montreal between 1985 and 1989. Of these, 16 mortally ill, being sustained in hospital by the intravenous administration of inotropic agents (15 patients [94%]) or intra-aortic balloon counterpulsation (6 [38%]). There was one early death (at 7 days), for a death rate of 6.3% (versus 8.6% for the 70 "elective" transplants). Two others died of delayed infection: one of viral hepatitis at 6 weeks, and one of pneumonia due to Pneumocystis 4 months after transplantation. The other 13 patients are alive and well 12 to 66 months postoperatively. Nine have returned to their preoperative work, three have decreased activity levels but are functioning well, and one is retired.