DIFFERENT RESULTS OF CARDIAC TRANSPLANTATION IN PATIENTS WITH ISCHEMIC AND DILATED CARDIOMYOPATHY

We retrospectively analyzed 275 consecutive transplanted patients, div iding them into group A (128 patients) affected by ischemic cardiomyop athy and group B (147 patients) affected by dilated cardiomyopathy. Th e difference in demographic, clinical and hemodynamic preoperative and postoperative data between the groups was studied; group A patients p resented at transplantation with a less compromised hemodynamic pictur e, requiring inotrope infusion and mechanical assistance less frequent ly. The influence of etiology on early postoperative complications was also analyzed: group A patients needed postoperative mechanical assis tance, inotrope, infusion and prolonged mechanical ventilation more of ten, therefore requiring a longer stay in the intensive care unit (ICU ). Hospital mortality was twice as high in group A. The older age of g roup A patients per se did not influence these results significantly, The long-term follow-up was then studied with particular attention to parenchymal functions, hemodynamics, coronary artery disease, metaboli c and surgical complications, and survival. The complication rate was higher in group A, with more severe hypertension and higher cholestero l levels at 1 year, a higher prevalence of accelerated coronary artery disease (CAD) and a more frequent onset of insulin-dependent diabetes . Surgical and vascular complications were also more frequent. The fin al result was a better 5-year actuarial survival rate for group B pati ents. Donor and recipient ages at the time of transplant did not influ ence this result. We conclude that ischemic patients, even if they are transplanted in better condition and operated more electively, have a more critical early and long-term postoperative course and a worse su rvival rate. These findings are not explained by advanced age, but cou ld be due to the impact of atherosclerosis and metabolic impairments a ssociated with ischemic disease.