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Orthotopic Heart Transplantation: Management and Results

  • Kazutomo Minami
  • Herbert Posival
  • Michael M. Körner
  • Ali El-Banayosy
  • Latif Arusoglu
  • Reiner Körfer
Chapter

Summary

Between March 1989 and December 1991, 316 orthotopic heart transplantations (HTX) were performed at the Heart Center North Rhine-Westfalia (NRW), Bad Oeynhausen, in 311 patients (267 men, 44 women). Five patients required retransplantation. The age of the recipients ranged from 3 days to 73 years (mean: 51 years). There were 16 children under 18 years old. The age of the donors ranged from 0.5 to 61 years (mean: 38 years). The main indications for HTX were dilatative cardiomyopathy (DCM; n = 142), end-stage ischemic heart disease (IHD; n = 139), valvular disease (VD; n = 19), and congenital heart disease (CHD; n = 10). One woman was transplanted for acute myocarditis (Coxsackie). In 11 patients a ventricular assist device (VAD) was applied as a bridging for HTX. In 7 of these 11 patients HTX was performed; 6 patients survived. Immunosuppresive protocols were based on “double drug therapy” with cyclosporine and azathioprine. More than two-thirds of the patients have had no long-term corticosteroid treatment. Early mortality (<30 days) was 7.2% (n = 23). According to the primary diagnosis, patients with DCM had the lowest mortality, 1.3% (2/142), followed by IHD, 6.4% (9/139), VD 21% (4/19), and CHD 60% (6/10). The causes of death were multiorgan failure (n = 7), sepsis (n = 4), acute rejection (n = 3), bleeding (n = 3), acute respiratory distress syndrome (ARDS) (n = 1), right heart failure (n = 3), size-missmatch (n = 1), and stroke (n = 1). Two of five patients (40%) with re-HTX died in the early postoperative period. Late mortality was 11.7% (n = 37). The causes of death were infection (n = 25), rejection (n = 10), and cancer (n = 2). The majority of the survivors returned to a productive lifestyle. This impressive number of HTX with these satisfying results was made possible by (1) perfect organization, (2) the creation of new and extended donor criteria, (3) special immunosuppresive treatment (“double drug therapy” whenever possible).

Key Words

Orthotopic heart transplantation Double drug therapy Results 

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Copyright information

© Springer Japan 1993

Authors and Affiliations

  • Kazutomo Minami
  • Herbert Posival
  • Michael M. Körner
  • Ali El-Banayosy
  • Latif Arusoglu
  • Reiner Körfer
    • 1
  1. 1.Department of Thoracic and Cardiovascular SurgeryHeart Center North Rhine-WestfaliaBad OeynhausenGermany

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