HETEROTOPIC HEART-TRANSPLANTATION - CATHETERIZATION, ENDOMYOCARDIAL BIOPSY, AND CORONARY ANGIOGRAPHY OF THE DONOR HEART

Follow-up after heart transplantation presently requires invasive tech niques to assess graft viability and function. As the heterotopic tran splant technique assumes a more important therapeutic role for patient s not eligible for an orthotopic allograft, an understanding of the in herent challenges associated with management of these patients is mand atory to optimize patient care. Heterotopic transplant technique was u sed in 19 of 135 (14%) consecutive heart transplant procedures over a 41 month period. Invasive diagnostic procedures performed in follow-up revealed 1) adequate tissue for histologic evaluation in 140/158 (89% ) biopsy procedures, 2) successful pulmonary wedge pressure measuremen ts in 142/158 (90%) right heart catheterizations, and 3) successful co ronary arteriography in 18 patients undergoing angiography (both vesse ls in 12 and one vessel in six patients). Thus, biopsy and surveillanc e procedures are feasible and productive in patients who have undergon e heterotopic heart transplantation. Background: Although heterotopic heart transplantation has become an increasingly utilized therapy for some patients with heart failure, there are no guidelines for routine biopsy and angiographic techniques in these patients. The objective of this study was to determine the feasibility of angiographic and endom yocardial biopsy procedures in heterotopic heart transplant recipients . Methods: The complete experience with heterotopic heart transplant r ecipients at Baylor College of Medicine and The Methodist Hospital ove r a 41 month period including endomyocardial biopsy, right heart cathe terization, and selective coronary arteriography results were analyzed . Results: Eighteen patients underwent 310 procedures without signific ant complications. Of 158 biopsy procedures, 140 (89%) yielded tissue adequate for histologic evaluation. Right heart pressures were obtaine d in almost all patients undergoing right heart catheterization. Pulmo nary wedge pressures were obtained in 137 (90%). A rapid decrease in r ight heart pressures was noted following transplant; however, a gradua l but significant rise in mean arterial pressure occurred. Eighteen se lective coronary arteriogram procedures were performed; 12 (66%) resul ted in successful cannulation of both coronary arteries. Of 12 patient s followed for at least 1 year, five (40%) have developed evidence of allograft arteriopathy. The 1 and 2 year survival rates were 67% and 5 3%, respectively. Conclusions: Invasive diagnostic techniques can be p erformed safely and reliably and should not preclude the use of hetero topic heart transplantation in selected patients who are otherwise uns uitable for orthotopic transplantation. (C) 1994 Wiley-Liss, Inc.