Heterotopic heart transplantation--a means to increase donor availability.
From November 1985 to August 1989, 105 patients underwent heart transplantation at our institution of whom 8 (7%) underwent heterotopic heart transplantation (HHTx). There were 7 males and 1 female with a mean age of 49 +/- 6 years (range, 41-58 years), 7 of whom had ischaemic cardiomyopathy and 1 had dilated cardiomyopathy. The indications for HHTx were gross donor/recipient size mismatch, unreliable donor heart, elevated pulmonary vascular resistance and the need for urgent transplantation or their combination. HHTx was performed as a left ventricular bypass in 6 patients and as biventricular bypass in 2 combined with various surgical procedures on the native heart in 5. There was one perioperative death with a mean follow-up of the survivors of 17 +/- 10 months (range, 6-30 months). Comparison of preoperative and postoperative (1 year) 2-D echocardiographic studies of the native heart showed haemodynamic stability of the latter with no substantial changes in left ventricular ejection fraction and cardiac index, while left ventricular end-diastolic volume tended to increase in 2 patients. In conclusion, preservation of the native heart allows recovery or growth of a graft considered unsuitable for orthotopic transplantation. Our experience confirms that HHTx may still be considered a valuable alternative to orthotopic transplantation in selected patients, thus expanding donor utilization.
Livi
U
U
Department of Cardiovascular Surgery, University of Padova Medical School, Italy.
Faggian
G
G
Chiominto
B
B
Mazzucco
A
A
Bortolotti
U
U
Gallucci
V
V
D000206:Actuarial Analysis; D000293:Adolescent; D000328:Adult; D002648:Child; D003327:Coronary Disease / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D016027:Heart Transplantation; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D014019:Tissue Donors / Q000600:supply & distribution*; D016042:Transplantation, Heterotopic / Q000401:mortality