Heterotopic heart transplantation for selected high-risk patients

Summary

Since July 1982, 349 patients have undergone heart transplantation at the Texas Heart Institute; 15 of those had heterotopic heart transplantations. Their indications were pulmonary hypertension (PH) in 11 patients, body-weight mismatch in 3, and pulmonary hypertension with compromised donor heart in one. The one-year actuarial survival rate for the heterotopic group is 82% compared with 77% for the orthotopic group. In the heterotopic group, 8 patients had right pleural effusions and 4 of them required thoracentesis. After an early recovery period, these patients tolerated further therapy. Angina of the native heart was experienced in two. This symptom disappeared after the native heart lost its function. Only one patient experienced a reversible neurologic problem caused by an embolism, in spite of anticoagulant therapy. Patients with a high risk condition such as PH may have a successful transplantation with the heterotopic technique. Heterotopic heart transplantation is technically more demanding, and postoperative management differs from that after orthotopic transplantation. From our experience, however, these problems are readily manageable and resolved without permanent sequelae. The heterotopic heart transplant procedure is a reliable surgical option for well-selected highrisk patients.