Heart-lung transplantation for primary pulmonary hypertension

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.