Native heart complications after heterotopic heart transplantation: Insight into the potential risk of left ventricular assist device

Background: In heterotopic heart transplantation, the donor heart is connec ted parallel to the recipient's diseased heart. Recipients continue to have risks, such as arrhythmia, thromboembolism, valvular heart disease, and is chemic heart disease which can develop in the native heart. It may serve as a clinical model to study long-term pathophysiologic processes in the nati ve heart of patients with a left ventricular assist device. Method: We analyzed the prevalence of long-term complications related to th e native heart in the heterotopic heart transplant and attempted to gain in sight into the potential risk to a native heart after receiving a left vent ricular assist device. Results: Between December 1984 and December 1994, 16 patients (13 men, 3 wo men, ranging in age from 37 to 60 years) underwent heterotopic heart transp lant at the University of Pittsburgh. The 1- and 5-year survival rate after the transplant was 81% and 44%, respectively. Actuarial freedom from compl ications related to the native heart after 1 year and 4 years was ventricul ar arrhythmia: 85%, 75%; ischemic disease: 85%, 64%; valvular disease: 100% , 88%; and thromboembolism: 85%, 58%. Of these complications, thromboemboli sm was not considered in determining actuarial freedom from complications b ecause thromboembolism should be regarded as a device-related complication rather than as a native-heart-related complication for left ventricular ass ist device recipients. Consequently, actuarial freedom from all complicatio ns excluding thromboembolism was 70% after 1 year and 50% after 4 years. In addition, the hazard function curve remains constant up to 80 months after the operation without significant differences among the yearly ratios. Conclusions: This analysis suggests that cautious observation of the native heart's long-term performance is necessary for the left ventricular assist device recipient.