Background: Heart transplantation currently provides the most effective tre
atment for advanced heart failure. However, medical therapy for this condit
ion has also improved, heart donors are scarce and the cost of the procedur
e is high. Therefore the indications and management of these patients need
reevaluation. Aim: To analyze the results of 24 patients submitted to heart
transplantation for end-stage hart failure needing repeated hospitalizatio
ns and i.v. inotropes for compensation. Patients and methods: The group was
comprised by 21 men and 3 women with a mean age of 36.8 years, mean left v
entricular ejection fraction 19+/-4.5%, mean systolic pulmonary artery pres
sure 48+/-13 mmHg (24-70) and mean pulmonary vascular resistance 2.6 Wood U
nits (1-5). Fourteen patients (58%) had a previous median sternotomy. Immun
osupression did not include induction therapy and steroids were discontinue
d early. Results: Operative mortality was 4% at 30 days. Actuarial survival
at one year was 90% and at 5 years 72%. Freedom from rejection at one year
was 70% at one year and 56.5% at five years. All patients with more than 3
months of follow-up were in functional class I. Conclusions: These results
justify the proposed modifications for transplantation protocols.