Related Experiment Videos
High-risk cardiac operation: a viable alternative to heart transplantation
M R Johnson1, M R Costanzo-Nordin, A L Heroux
1Department of Medicine, Loyola University of Chicago, Maywood, Illinois 60153.
Insights
High-risk heart operations with circulatory support offer a viable alternative for heart transplant candidates. This approach demonstrates good short-term survival and functional improvement, potentially avoiding direct heart transplantation.
Area of Science:
- Cardiology
- Cardiac Surgery
- Transplantation Medicine
Background:
- Heart transplantation is a definitive treatment for end-stage heart failure.
- High-risk patients may not be suitable for direct transplantation.
- Circulatory support technologies offer new therapeutic avenues.
Purpose of the Study:
- To evaluate the safety and efficacy of high-risk cardiac operations in heart transplant candidates.
- To assess outcomes of patients offered surgery with circulatory support standby instead of immediate transplantation.
Main Methods:
- Retrospective review of 21 heart transplant candidates offered surgery.
- Procedures included coronary artery bypass grafting, valve replacement, and defibrillator implantation.
- Intra-aortic balloon pump and biventricular assist device support were utilized as needed.
Main Results:
- Ninety percent of patients (19/21) were alive at a mean follow-up of 10.5 months.
- Significant improvement in New York Heart Association functional class from 3.4 to 1.9.
- No patients underwent transplantation during the follow-up period; two are awaiting organs.
Conclusions:
- High-risk cardiac operations with circulatory support are a feasible alternative to direct heart transplantation in selected patients.
- This strategy can improve functional status and survival without immediate need for donor organs.
- Further research should explore long-term outcomes and patient selection criteria.
Abstract:
To determine if high-risk heart operation with circulatory support standby is an acceptable alternative to direct heart transplantation, we reviewed 21 patients who were accepted as heart transplant candidates but offered a heart operation because of the availability of circulatory support. Preoperative left ventricular ejection fraction was 0.25 +/- 0.08 (mean +/- standard deviation), and New York Heart Association functional class was 3.4 +/- 0.7. The patients underwent 16 bypass graft operations, 4 mitral and 2 aortic valve replacements, and 4 defibrillator implantations (combined procedures in 5 patients). An intraaortic balloon pump was placed in 12 patients. One patient required biventricular assist device support but was weaned in 11 days. Twenty patients were discharged 14.8 +/- 11.5 days postoperatively. One patient died 15 days postoperatively of amiodarone-induced respiratory failure, and 1 died suddenly 2 months postoperatively. At 10.5 +/- 6 months postoperatively, 19 patients (90%) are alive. Mean functional class is 1.9 +/- 0.9. None of the patients has undergone transplantation, but 2 are awaiting donor organs. We conclude that in selected heart transplant candidates high-risk heart operation is a viable alternative to direct heart transplantation.