Background. The operation of choice for primary pulmonary hypertension rema
ins controversial, as heart-lung transplantation, single-lung transplantati
on, and double-lung transplantation have all been advocated.
Methods. We reviewed our institution's experience with heart-lung transplan
tation for primary pulmonary hypertension.
Results. Thirty-nine patients had heart-lung transplantation for primary pu
lmonary hypertension. Operative mortality rate was 18%, and actuarial survi
val was 72% at 1 year, 67% at 2 years, and 42% at 5 years. Freedom from obl
iterative bronchiolitis was 91% at 1 year, 83% at 2 years, and 70% at 5 yea
rs. Freedom from obliterative bronchiolitis-related death was 100% at 1 yea
r, 90% at 2 years, and 87% at 5 years. Freedom from accelerated graft coron
ary disease was 92% at 5 years. The most frequent causes of death were infe
ction, obliterative bronchiolitis, and accelerated graft coronary disease,
Conclusions. Heart-lung transplantation results in survival comparable to t
hat reported for single or double lung transplantation. Obliterative bronch
iolitis is a significant cause of late death but seems to occur less freque
ntly with heart-lung transplantation than with lung transplantation alone.
Accelerated coronary graft disease is rare in the first 5 years after trans
plantation. (Ann Thorac Surg 1999;67:937-42) (C) 1999 by The Society of Tho
racic Surgeons.