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Heart transplantation--Stanford experience
1Department of Cardiovascular Surgery, Stanford University, CA.
Insights
Heart transplantation is now a viable treatment for end-stage heart disease, with survival rates improving significantly. Advancements in immunosuppression and devices like the Novacor LVAD enhance patient outcomes.
Area of Science:
- Cardiology
- Transplantation Medicine
- Medical Devices
Background:
- Heart transplantation has transitioned from experimental to a standard therapy for end-stage heart disease.
- Significant advancements in immunosuppression and surgical protocols have improved outcomes.
- The increasing number of heart transplants reflects its growing acceptance and efficacy.
Purpose of the Study:
- To review the outcomes of heart transplantation at Stanford University.
- To assess the role of left ventricular assist devices as a bridge to transplantation.
- To highlight trends and future considerations in cardiac transplantation.
Main Methods:
- Retrospective analysis of 429 cardiac transplant recipients at Stanford since 1968.
- Review of immunosuppression protocols, primarily a 3-drug regimen (cyclosporine, azathioprine, prednisone).
- Evaluation of 6 patients receiving a Novacor left ventricular assist device as a bridge to transplant.
Main Results:
- Recipient diagnoses included cardiomyopathy (205), coronary artery disease (188), and valvular heart disease (20).
- One- and 5-year survival rates are 83% and 55%, respectively.
- Three of four patients bridged with a Novacor LVAD survived post-transplant.
Conclusions:
- Heart transplantation is a successful therapeutic option for end-stage heart disease.
- Improved immunosuppression and standardized protocols have driven the rise in transplant numbers.
- Future challenges include donor allocation and establishing center standards for heart transplantation.
Abstract:
Heart transplantation has evolved from an experimental procedure with minimally acceptable results to a therapeutic option for patients with end-stage heart disease. Since 1968, 429 patients have undergone cardiac transplantation at Stanford. The recipient diagnosis was cardiomyopathy in 205 patients, coronary artery disease in 188, and valvular heart disease in 20 patients. The age range was 5 months to 60 years with equal survival among children and adults. Immunosuppression included a 3-drug protocol of CsA, azathioprine, and prednisone. The current one- and 5-year survival is 83% and 55%, respectively. A totally implantable electrically driven left ventricular assist device (Novacor) has been implanted in 6 patients as a "bridge-to-transplantation." Four patients received cardiac transplants after a mean support period of 7 days (range 2.0-16.5 days). Of the four transplanted patients, 3 (75%) are alive at 32, 11, and 4 months. With improved immunosuppression and standardized protocols, heart transplantation has been successfully employed by many centers. The number of heart transplants has risen from 103 in 1982 to 719 in 1985. Undoubtedly, due to the expanding number of centers, future issues will include distribution of donors and minimal acceptable standards for heart transplantation centers.