Korean J Crit Care Med.  2001 Jun;16(1):23-29.

Heart Transplantation. A Retrospective Analysis of the Short and Intermediate Term Results

• Choo SJ
• Oh JH
• Kim JJ
• Song MG

Abstract

BACKGROUND
Heart transplantation is still the best therapy for end-stage heart disease. However, the longterm outcome among different institutions vary. The current series is an assessment of the important factors which determine prognosis.
METHODS
Between November of 1992 and September of 2000, 85 heart transplantations were performed at our institution. The standard technique was used in the first 57 patients (group I) where as in the latter 28 patients (group II), the Bicaval technique was utilized. The mean waiting time was approximately 4.7 months, and the causes in decreasing order were Dilated cardiomyopathy (n=69), Ischemic cardiomyopathy (n=10), Hypertrophic cardiomyopathy and others (n=6). The mean follow up was about 31 months. The immunosuppressive protocol comprised cyclosporin, Azathioprine (AZA), and prednisone. Later changes included induction with IL-2 receptor monoclonal antibody and changing AZA to mycophenolate mofetil.
RESULTS
The mean donor ischemic time was 95.8 28.3 mins and the implantation time was 59.3 7.6 mins. There was a higher incidence of significant TR in group I along with a greater postoperative pacing requirement. There were 35 postoperative complications of which infectious events were most common (26). Of these, only 3 were early infections and the rest occurred late postoperatively. There were a total of 8 mortalities of which only one occurred early postoperatively and among the 7 late deaths, 3 were medically related and 4 were related to social factors. Only 5% of the patients had graft vascular disease. The overall 1YSR was 92% and the 5 YSR was 85%.
CONCLUSIONS
The superior long term results of this current series was attributable to strong early immunosuppression, a homogenous population, and very low incidence of CMV infection.

Keyword

Standard technique; Bicaval technique; Heart transplantation; Dilated cardiomyophathy

MeSH Terms

Azathioprine
Cardiomyopathies
Cardiomyopathy, Dilated
Cardiomyopathy, Hypertrophic
Cyclosporine
Follow-Up Studies
Heart Diseases
Heart Transplantation*
Heart*
Humans
Immunosuppression
Incidence
Mortality
Postoperative Complications
Prednisone
Prognosis
Receptors, Interleukin-2
Retrospective Studies*
Tissue Donors
Transplants
Vascular Diseases
Azathioprine
Cyclosporine
Prednisone
Receptors, Interleukin-2