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Long-term outcome after heart transplantation for peripartum cardiomyopathy
P R Rickenbacher1, M N Rizeq, S A Hunt
1Division of Cardiovascular Medicine, Stanford University Medical Center, CA 94305.
Insights
Heart transplantation offers a viable treatment for peripartum cardiomyopathy (PPCM) when conventional methods fail. Outcomes and complications after PPCM heart transplants are comparable to those for idiopathic dilated cardiomyopathy (IDCM).
Area of Science:
- Cardiology
- Transplantation Medicine
Background:
- Peripartum cardiomyopathy (PPCM) is a rare form of heart failure specific to pregnancy.
- Management of end-stage PPCM often requires advanced therapies, including heart transplantation.
- Long-term outcomes for PPCM patients undergoing heart transplantation are not well-established.
Purpose of the Study:
- To compare the long-term outcomes and complication rates of heart transplantation in patients with PPCM versus those with idiopathic dilated cardiomyopathy (IDCM).
- To evaluate the efficacy and safety of heart transplantation as a treatment for PPCM.
Main Methods:
- Retrospective comparison of eight PPCM patients with nine age-matched female IDCM patients undergoing heart transplantation.
- Analysis of baseline variables, survival rates, rejection rates, infection rates, and rehabilitation status.
- Actuarial survival analysis and linearized rejection/infection rates were calculated.
Main Results:
- No significant differences in baseline variables except for a higher number of pregnancies in the PPCM group.
- Similar 1-year and 5-year actuarial survival rates between PPCM (75%, 60%) and IDCM (78%, 78%) groups.
- Comparable linearized rejection and infection rates, and similar rates of rehabilitation and hemodynamic recovery post-transplant.
Conclusions:
- Heart transplantation is a valuable and effective treatment option for patients with PPCM and severe, refractory congestive heart failure.
- Long-term outcomes and complication profiles following heart transplantation for PPCM are similar to those for IDCM.
- Further research may explore specific PPCM-related factors influencing transplant outcomes.
Abstract:
To elucidate the long-term outcome and frequency of complications after heart transplantation for peripartum cardiomyopathy (PPCM), we compared the courses of eight consecutive patients undergoing transplantation for PPCM with those of nine female age-matched control subjects undergoing transplantation for idiopathic dilated cardiomyopathy (IDCM). No significant differences could be found in baseline variables between the two groups with the exception of the number of pregnancies (2.5 +/- 1.5 vs 0, p = 0.0002). Two patients in each group died during the first 6 months after transplantation, and one in each group died later. Actuarial survival rates were 75% +/- 15% and 78% +/- 14% (p = NS) at 1 year and 60% +/- 18% and 78% +/- 14% (p = NS) at 5 years in PPCM and IDCM patients, respectively. Linearized rejection rates during the first 3 months were 1.85 +/- 0.56 and 1.91 +/- 0.49 (p = NS) and during the second 3 months were 0.18 +/- 0.18 and 0.45 +/- 0.26 (p = NS), respectively. Similarly no significant differences in linearized infection rates were found. Among patients surviving more than 6 months after transplantation, after a mean follow-up period of 4.5 +/- 3.1 years for those with PPCM and 7.8 +/- 3.2 years for those with IDCM, 83% and 100%, respectively, were rehabilitated; hemodynamic findings were normal in all patients and the frequency of other transplant-associated complications was similar in both groups. In conclusion, heart transplantation is a valuable option for patients with PPCM and severe congestive heart failure that is unresponsive to conventional treatment.(ABSTRACT TRUNCATED AT 250 WORDS)