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Mid-term results of heart transplantation for end-stage valvular disease
U Livi1, A L Caforio, G M Boffa
1Department of Cardiovascular Surgery, University of Padova Medical School, Italy.
Insights
Heart transplantation outcomes for end-stage valvular disease patients show similar survival and complication rates compared to other heart transplant recipients. This suggests valvular disease is not a significant factor in post-transplant success.
Area of Science:
- Cardiology
- Transplantation Medicine
- Cardiac Surgery
Background:
- End-stage valvular disease frequently leads to heart failure and necessitates advanced treatment.
- Heart transplantation is a viable option for patients with end-stage heart failure, including those with valvular disease.
- Previous valve surgery is common in patients with end-stage valvular disease considered for heart transplantation.
Purpose of the Study:
- To retrospectively analyze the outcomes of heart transplantation in patients with end-stage valvular disease.
- To compare the morbidity and mortality rates of these patients with those transplanted for other etiologies.
- To assess graft function and complication incidence in valvular disease heart transplant recipients.
Main Methods:
- Retrospective analysis of 19 consecutive end-stage valvular disease patients undergoing heart transplantation.
- Comparison of outcomes (mortality, survival, rejection, infection) with a cohort of non-valvular disease heart transplant patients.
- Evaluation of graft function, kidney and liver function, and coronary lesions at 1 year post-transplantation.
Main Results:
- In-hospital mortality was 21% and late mortality was 5%.
- One-year and 5-year actuarial survival rates were similar to patients transplanted for other causes (74% vs 77% at 5 years).
- Incidence of acute rejection, infection, preserved kidney and liver function, and normal graft function were comparable between groups.
Conclusions:
- Heart transplantation for end-stage valvular disease appears to have similar morbidity and mortality rates compared to other indications.
- Valvular disease etiology does not significantly impact short-term or long-term outcomes after heart transplantation in this series.
- Further research with larger cohorts is warranted to confirm these findings.
Abstract:
The results of heart transplantation in a consecutive series of 19 end-stage valvular disease patients (15 male, aged 48 +/- 8 years) were analysed retrospectively. The indication for heart transplantation was heart failure due to left and/or right ventricular dysfunction; 16 patients had undergone previous valve surgery, but prosthetic dysfunction was present in only one patient. All patients were in NYHA class IV, 15 were on oral anticoagulants and 5 on i.v. catecholamine support. There were four in-hospital deaths (21%) and one late death (5%), resulting in a 1-year mortality rate slightly, but not significantly, higher than that of patients transplanted for other indications (16%). Mean follow-up of the survivors was 48 +/- 33 months (range 9-95); 5-year actuarial survival was similar to that observed among the other heart transplantation patients (74 +/- 10% vs 77 +/- 3%, P = NS). The incidence of acute rejection and infection was also similar in valvular disease and non-valvular disease patients. Kidney and liver function at 1 year post-heart transplantation was preserved in all cases; cardiac catheterization revealed normal graft function in all patients and the absence of coronary lesions in all but two. In conclusion, in our limited experience morbidity and mortality in patients transplanted for end-stage valvular disease seem to be similar to those of patients undergoing heart transplantation for other etiologies.