Related Experiment Videos
Heart transplantation: a single-center experience
1Klinik für Herz-, Thorax- und Gefässchirurgie, Deutsches Herzzentrum Berlin, Germany.
Insights
Heart transplantation is effective for end-stage heart failure, even with expanded donor and recipient criteria. Donor organ scarcity remains a significant challenge for this life-saving procedure.
Area of Science:
- Cardiology
- Transplantation Medicine
- Medical Technology
Background:
- Heart transplantation criteria for recipients and donors have been expanded due to the procedure's success.
- This study evaluates the single-center experience with heart transplantation for end-stage heart failure.
Purpose of the Study:
- To assess the outcomes of heart transplantation with broadened donor and recipient criteria.
- To evaluate the effectiveness of ventricular assist devices as a bridge to heart transplantation.
Main Methods:
- A retrospective analysis of 1,413 patients undergoing heart transplantation between April 1986 and January 1996.
- Ventricular assist devices (VADs) were used in 173 patients as a bridge to transplantation, with a maximum support duration of 572 days.
Main Results:
- 891 patients received heart transplants; 522 died awaiting organs. Average wait time was 107 days.
- Recipient age averaged 44 years, with donors up to 69 years. 48% of VAD patients underwent transplantation.
- 30-day mortality was 14%; 1, 5, and 10-year survival rates were 80%, 59%, and 50%. 94% achieved NYHA class I/II at 1 year.
Conclusions:
- Heart transplantation remains effective for end-stage heart failure despite wider selection criteria.
- A significant gap between donor organ availability and patient need limits the therapeutic approach.
Background:
The success of heart transplantation led to the extension of the criteria for both recipients and donors. The aim of the study was to evaluate the experience with this therapeutic approach for end-stage heart failure at a single center.
Methods:
Between April 1986 and January 1996, 1,413 patients were accepted as candidates for heart transplantation. Ventricular assist devices were used as a bridge to transplantation in 173 patients (biventricular assist device in 141 patients and left ventricular assist device in 32 patients). The longest duration of support was 572 days (average, 46 days).
Results:
Of the 1,413 patients, 891 underwent heart transplantation (65 children/adolescents and 826 adults; 522 (36%) patients died awaiting a donor heart. The average time spent on the waiting list was 107 days. The average recipient age was 44 years, and the age of donors was extended up to 69 years. Eighty-three patients with ventricular assist devices (48%) subsequently underwent heart transplantation. Twenty-five patients (2.7%) underwent retransplantation. The 30-day mortality rate was 14%, and the overall actual survival at 1, 5, and 10 years was 80%, 59%, and 50%, respectively. Ninety-four percent of patients were in New York Heart Association functional class I or II at 1 year, and 44% returned to work after transplantation.
Conclusions:
Despite the broadening of the selection criteria for both recipients and donors, heart transplantation remains an effective treatment for end-stage heart failure. Nevertheless, this therapeutic approach is severely limited by a considerable disparity between the need and availability of donor organs.