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[Surgical and perioperative problems of heart transplantation]
A Laske1, E Bauer, L von Segesser
1Klinik für Herzgefässchirurgie, Universitätsspital Zürich.
Insights
Orthotopic heart transplantation offers good survival rates for end-stage heart disease. This study of 79 transplants shows effective immunosuppression and management lead to excellent patient outcomes and quality of life.
Area of Science:
- Cardiology
- Transplant Surgery
Context:
- Orthotopic heart transplantation is a critical treatment for terminal cardiac diseases.
- Minimizing ischemic time and accurate donor evaluation are crucial for successful outcomes.
Purpose:
- To report outcomes of 79 orthotopic heart transplantations performed between September 1985 and October 1989.
- To evaluate the efficacy of triple immunosuppression therapy and management strategies.
Summary:
- The study involved 79 orthotopic heart transplantations in 78 patients, with average ischemic times reported.
- Immunosuppression using triple therapy (Cyclosporin A, Azathioprim, Prednisone) was well-tolerated.
- Effective management of rejection and infections contributed to good short- and medium-term survival.
Impact:
- Actuarial survival rates reached 91% at one and two years, and 85% at three years.
- Patients experienced a good quality of life, achieving NYHA class I.
- Prophylactic treatment for cytomegalovirus and toxoplasmosis is recommended for high-risk patients.
Abstract:
Orthotopic heart transplantation is an established treatment for terminal cardiac diseases. Close cooperation and coordination with other clinics and laboratories is mandatory to transplant a good organ with minimal ischemic time. Accurate donor evaluation and treatment is essential for fast recovery after operation. Our series is 79 orthotopic heart transplantations form 9/85 to 10/89 in 78 patients. Average ischemic time is 38 minutes in organ procurement from table to table and rises distinctly in distal heart procurement (n = 33), but is usually under 120 minutes at organ procurement from any place in Switzerland. The transplantation is performed in the technique from Lower and Shumway. Immunosuppression with triple therapy (Cyclosporin A, Azathioprim, Prednisone) and initial cytolytic therapy is well tolerated. Consequent diagnosis and treatment for rejection and infections lead to good short and medium term survival. Prophylactic treatment is indicated in high risk constellation for cytomegalovirus and toxoplasmosis infection. Early mortality (less than 30 days) was two out of seven and caused by bacterial infections. Actuarial survival is 91% at one and two years and 85% at three years with good quality of life and NYHA class I.