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High-risk heart surgery in the heart transplant candidate
B M Blakeman1, R Pifarré, H Sullivan
1Department of Thoracic and Cardiovascular Surgery, Loyola University Medical Center, Maywood, Ill.
Insights
Conventional heart surgery offers a viable alternative for select high-risk patients awaiting heart transplantation. Many patients avoided transplantation, demonstrating the effectiveness of surgical interventions for specific cardiac conditions.
Area of Science:
- Cardiology
- Cardiac Surgery
- Transplantation Medicine
Background:
- Limited donor heart availability necessitates alternative treatments for heart transplant candidates.
- A subset of patients referred for orthotopic heart transplantation may be suitable for conventional cardiac surgery.
- Identifying high-risk patient groups is crucial for optimizing treatment pathways.
Purpose of the Study:
- To evaluate the outcomes of conventional heart surgery in patients referred for orthotopic heart transplantation.
- To determine the efficacy of surgical interventions as an alternative to heart transplantation in a high-risk cohort.
- To identify patient characteristics that predict successful outcomes with conventional surgery versus transplantation.
Main Methods:
- Retrospective analysis of 20 patients undergoing conventional heart surgery who were initially referred for heart transplantation.
- Nonrandomized selection for conventional surgical procedures.
- Assessment of survival rates and avoidance of heart transplantation post-surgery.
Main Results:
- 17 out of 20 patients (85%) survived hospitalization.
- 11 out of 20 patients (55%) avoided heart transplantation or being added to the transplant list.
- Patients with poor ventricular function and arrhythmias, or those undergoing first-time revascularization, had favorable outcomes (10/10 survival).
- Patients with poor ventricular function requiring redo bypass surgery experienced poor results (3/6 mortality).
Conclusions:
- Conventional heart surgery can be a successful alternative for carefully selected high-risk patients referred for heart transplantation.
- Patients with poor ventricular function undergoing redo bypass surgery represent a particularly high-risk group and warrant careful consideration for initial heart transplantation.
- Further research into patient selection criteria for surgical alternatives to heart transplantation is warranted.
Abstract:
Because of the limited supply of donor hearts, transplant physicians are searching for alternative treatments for patients referred for orthotopic heart transplantation. A group of 20 patients (7% of patients accepted for heart transplantation at Loyola University Medical Center) were nonrandomly sent for conventional heart surgery. Of 20 patients, 17 survived their hospitalization, and 11 of the original 20 have avoided heart transplantation or having their names added to the transplant list. This group represents a high-risk subset of patients. Patients with poor ventricular function and ventricular arrhythmias or with poor ventricular function who underwent first-time revascularization were well served by more conventional heart surgery (all 10 patients survived surgery). Patients with poor ventricular function who required redo bypass operation had a poor result (three of six died), and such patients should be considered carefully for initial heart transplantation.