ROLE OF ORTHOTOPIC HEART-TRANSPLANTATION IN THE MANAGEMENT OF PATIENTS WITH RECURRENT VENTRICULAR TACHYARRHYTHMIAS FOLLOWING MYOCARDIAL-INFARCTION

Objective-To report the outcome of an intention to treat by heart tran splantation strategy in two groups of patients after infarction, one w ith both left ventricular failure (LVF) and ventricular tachyarrhythmi as (VTA) (group A) and the other with progressive LVF following antiar rhythmic surgery for VTA (group B). Patients and methods-Group A compr ised 17 consecutive patients for whom transplantation was considered t he best primary non-pharmacological treatment; group B comprised five consecutive patients assessed and planned for transplantation after an tiarrhythmic surgery. Results-In group A, eight patients underwent tra nsplantation and all survived the first 30 day period. At median follo w up of 55 months (range 11 to 109) seven of this subgroup were still alive. Five patients died of recurrent VTA before transplantation, des pite circulatory support. In the face of uncontrollable VTA, four of t hese underwent ''high risk'' antiarrhythmic surgery white awaiting tra nsplantation: three died of LVF within 30 days and one was saved by he art transplantation two days after arrhythmia surgery. Mortality for t he transplantation strategy in group A patients was 47% by intention t o treat analysis. Quality of life in the eight actually transplanted, however, was good and only one died during median follow up of 56 mont hs. The five patients in group B were accepted for transplantation for progressive LVF at a median of 21 months (range 12 to 28) after antia rrhythmic surgery. One died of LVF before transplantation, 22 months a fter initial surgery; another died of high output LVF three days after transplantation. Thus mortality of the intended strategy was 40%. The three transplanted patients are alive and well at 8-86 months. Conclu sions-Although the short and medium term outcome in category A or B pa tients who undergo transplantation is good, the overall success of the transplantation strategy in category A patients is limited by lack of donors in the short time frame in which they are required.