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[Dynamics of patient selection for heart transplantation or cardiomyoplasty]
H F de Freitas1, L Nastari, A J Mansur
1Instituto do Coração do Hospital das Clínicas-FMUSB, São Paulo.
Insights
A small fraction of patients are eligible for heart transplantation or dynamic cardiomyoplasty. Sociopsychic evaluations are crucial for patient selection and care in advanced heart failure management.
Area of Science:
- Cardiology
- Cardiac Surgery
- Transplantation Medicine
Context:
- Heart transplantation and dynamic cardiomyoplasty are advanced treatments for end-stage heart failure.
- Patient selection is critical to optimize outcomes and resource allocation.
- Diverse etiologies of heart failure, including cardiomyopathies and ischemic heart disease, were evaluated.
Purpose:
- To evaluate patient selection criteria for heart transplantation and dynamic cardiomyoplasty.
- To identify factors influencing eligibility and outcomes for advanced cardiac procedures.
Summary:
- Out of 380 patients evaluated, a small percentage (14.4% indicated, 5% performed) were eligible for heart transplantation.
- Dynamic cardiomyoplasty was indicated in 2.3% and performed in 2.1% of patients.
- Clinical contraindications (7.8%), socioeconomic (11.3%), and psychic limitations (6.0%) affected transplantation eligibility, alongside patient refusal (2.6%). Conventional surgery was indicated for 3.1%.
Impact:
- Highlights the limited eligibility for heart transplantation and dynamic cardiomyoplasty, necessitating careful patient selection.
- Emphasizes the importance of comprehensive sociopsychic evaluations in managing patients with advanced heart failure.
- Suggests potential for re-evaluation and alternative treatment strategies, such as conventional surgery, during patient follow-up.
Purpose:
To evaluate patient selection for heart transplantation or dynamic cardiomyoplasty.
Methods:
We evaluated 380 patients from April 1991 to July 1993. The ages ranged between 16 and 68 (mean 43.5 +/- 11.46) years, 303 (79.7%) were male. The diagnoses were dilated cardiomyopathy in 163 (42.9%), Chagas' cardiomyopathy in 70 (18.4%), ischemic heart disease in 61 (16.1%), hypertensive heart disease in 40 (10.5%), valvular heart disease in 23 (6.1%), alcoholic cardiomyopathy in 12(3.2%), peripartum cardiomyopathy in 5 (1.3%) and myocarditis of unknown etiology in 5 (1.3%).
Results:
The indication of heart transplantation was eventually done in 55 (14.4%), and 19 (5%) were submitted to transplantation. Dynamic cardiomyoplasty was indicated in 9 (2.3%) patients and was performed in 8 (2.1%). In 30 (7.8%) patients there were clinical contraindications for transplantation. Conventional surgical treatment was indicated for 12 (3.1%) patients: myocardial revascularization and/or ventricular aneurismectomy in 5, surgical treatment of valvular heart disease in 6 and of atrial fibrillation in 1. Socioeconomic limitations precluded transplantation in 43 (11.3%) and psychic limitations hindered transplantation in 23 (6.0%) patients. Refusal of procedure by the patient occurred in 10 (2.6%) cases. Improvement of the symptoms occurred in 69 (18.1%) patients.
Conclusion:
A small percentage of patients are eligible and are eventually submitted to heart transplantation or dynamic cardiomyoplasty. New strategies may be delineated during follow up, as deferring transplantation or conventional surgical treatment of ischemic or valvular heart disease. Sociopsychic evaluation is an important step in the care of the patients.