HEART-TRANSPLANTATION - A SINGLE-CENTER EXPERIENCE

Background. The success of heart transplantation led to the extension of the criteria for both recipients and donors. The aim of the study w as to evaluate the experience with this therapeutic approach for end-s tage heart failure at a single center. Methods. Between April 1986 and January 1996, 1,413 patients were accepted as candidates for heart tr ansplantation. Ventricular assist devices were used as a bridge to tra nsplantation in 173 patients (biventricular assist device in 141 patie nts and left ventricular assist device in 32 patients). The longest du ration of support was 572 days (average, 46 days). Results. Of the 1,4 13 patients, 891 underwent heart transplantation (65 children/adolesce nts and 826 adults; 522 (36%) patients died awaiting a donor heart. Th e average time spent on the waiting list was 107 days. The average rec ipient age was 44 years, and the age of donors was extended up to 69 y ears. Eighty-three patients with ventricular assist devices (48%) subs equently underwent heart transplantation. Twenty-five patients (2.7%) underwent retransplantation. The 30-day mortality rate was 14%, and th e overall actual survival at 1, 5, and 10 years was 80%, 59%, and 50%, respectively. Ninty-four percent of patients were in New York Heart A ssociation functional class I or II at 1 year, and 44% returned to wor k after transplantation. Conclusions. Despite the broadening of the se lection criteria for both recipients and donors, heart transplantation remains an effective treatment for end-stage heart failure. Neverthel ess, this therapeutic approach is severely limited by a considerable d isparity between the need and availability of donor organs.