ASSESSMENT OF A CONSECUTIVE SERIES OF 75 HEART-TRANSPLANTS

Objectives: The global results of various series of heart transplantat ion (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 Dec ember 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 2 2 were older than 60 years. Our series included more cases of ischaemi c heart disease (36) than dilated cardiomyopathies (33), with a histor y of cardiac surgery in almost one quarter (20) of patients with ischa emic heart disease. Results: The immediate postoperative survival rate was 94.7% with 3 deaths attributable to refractory pulmonary hyperten sion associated with graft failure and one death related to postoperat ive 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%. Elevan patients died between 4 and 38 months (mean: 18.2 month s). Two deaths were due to cancers, 4 were due to septicaemia, another 4 were due to rejection and finally 1 was due to meningeal haemorrhag e. 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 I-123-MIBG scintigraphy, the use of pulsatile circulatory assistance system, imp roved CMV, morphometry and donor-recipient age matching, should optimi ze the results of a technique, whose efficacy is confirmed in this ser ies.