Key result
Heterotopic heart transplantation carries high long-term mortality, with ~85% dying over extended follow-up.
Why the study?
The indications for heterotopic heart transplantation needed reassessment based on experience from a 9-year period at a single center.
Cohort (n=49)
No
Heterotopic heart transplantation is associated with high long-term mortality (22% 5-year survival), suggesting its indications should be restricted to specific scenarios such as elevated pulmonary vascular resistance or donor-recipient size mismatch.
Answers are grounded in this paper and cite their sources.
High mortality after heterotopic heart transplantation warrants clinical caution; leaves open its role versus orthotopic approaches in prospective studies.
In the 9-year period between November 1974 and December 1983, 49 patients underwent heterotopic heart transplantation at Groote Schuur Hospital. Eight patients subsequently underwent a further transplant procedure, and one of these a third transplant (58 transplants in 49 patients). Conventional immunosuppressive therapy (azathioprine, corticosteroids, and rabbit antithymocyte globulin) was used in 47 cases (81%), and cyclosporine and conventional immunosuppression in 11 (19%). Follow-up (to 1st January 1986) has been for a minimum of 2 and a possible maximum of 11 years. Forty-one of the 49 patients (85%) have subsequently died, mean survival of this group being 18.5 months. Mean survival of the 8 patients alive is 74 months. One-year survival has been 55% and 5-year survival 22%. In light of this experience, it would seem to us that the indications for heterotopic transplantation have now greatly diminished. There would still appear to be a place for it, however, when the donor heart is small in relation to the mass of the recipient, when there is a possibility of myocardial recovery following the resolution of a myocarditis, and when there is an elevated pulmonary vascular resistance which may make orthotopic transplantation hazardous. Heterotopic heart transplantation may also be indicated when the recipient circulation is failing rapidly despite maximal medical support, and therefore transplantation is urgent.
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Cooper et al. (1986) conducted a cohort in Heart failure requiring transplantation (n=49). Heterotopic heart transplantation was evaluated on Mortality and survival rates. Heterotopic heart transplantation resulted in an 85% mortality rate over 2 to 11 years of follow-up, with 1-year and 5-year survival rates of 55% and 22%, respectively.
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