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[Cardiac transplantation. Evaluation of a consecutive series of 75 grafts]
G Babatasi1, M Massetti, S Bhoyroo
1Service de Chirurgie Thoracique et Cardio-Vasculaire, CHU Caen Côte de Nacre, CAEN, France.
Insights
Heart transplantation (HT) offers significant life expectancy, but strict recipient selection is crucial due to graft shortages. This study confirms HT efficacy, highlighting the need for careful patient evaluation to optimize outcomes.
Area of Science:
- Cardiovascular Surgery
- Transplantation Medicine
- Immunology
Context:
- Heart transplantation (HT) is a vital treatment for end-stage heart failure.
- Graft availability remains a significant challenge in HT programs.
- Optimizing recipient selection is paramount for successful HT outcomes.
Purpose:
- To evaluate the global results and long-term survival rates of heart transplantation.
- To identify factors influencing patient outcomes following HT.
- To emphasize the importance of strict candidate selection for HT.
Summary:
- This series involved 75 orthotopic heart transplants (HT) between 1989 and 1994, with a mean patient age of 47.46 years.
- Immediate postoperative survival was 94.7%, with a 5-year actuarial survival rate of 56.8%.
- Causes of late mortality included cancers, sepsis, rejection, and meningeal hemorrhage, with reoperations for clot removal noted in 19 patients.
Impact:
- The findings underscore the efficacy of HT, supporting its continued role in managing heart failure.
- Strict recipient selection, potentially aided by 123I-MIBG scintigraphy, is recommended to improve HT success rates.
- Further optimization strategies include pulsatile circulatory assistance, improved CMV management, morphometry, and donor-recipient age matching.
Objectives:
The global results of various series of heart transplantation (HT) are essential to assess the life expectancy provided by this technique. Due to the increasing graft shortage, it appears essential to very strictly candidates for HT.
Methods:
From March 8, 1989 to December 7, 1994, 75 orthotopic Hts were performed in 62 men and 12 women (1 case of retransplantation). The mean age was 47.46 +/- 15.02 years (range: 2.5-66 years). Four patients were younger than 10 years and 22 were older than 60 years. Our series included more cases of ischaemic heart disease (36) than dilated cardiomyopathies (33), with a history of cardiac surgery in almost one quarter (20) of patients with ischaemic heart disease.
Results:
The immediate postoperative survival rate was 94.7% with 3 deaths attributable to refractory pulmonary hypertension associated with graft failure and one death related to postoperative tamponade. Five other patients died during the following 3 months, increasing the mean global survival to 88%. After a mean follow-up of 2.1 years (maximum 5.8 years), the actuarial 5-year survival rate was 56.8%. Eleven patients died between 4 and 38 months (mean: 18.2 months). Two deaths were due to cancers, 4 were due to septicaemia, another 4 were due to rejection and finally 1 was due to meningeal haemorrhage. The frequency (19) of reoperations for clot removal was due to the large number of patients with a history of previous heart surgery (20).
Conclusion:
Strict recipient selection, possibly based on 123I-MIBG scintigraphy, the use of pulsatile circulatory assistance systems, improved CMV, morphometry and donor-recipient age matching, should optimize the results of a technique, whose efficacy is confirmed in this series.