[The surgical alternative in the treatment of terminal cardiomyopathies: cardiac transplantation].
Between April 1983 and November 1985, 14 patients have undergone a heart transplant, or 10 men and 4 women, aged from 17 to 55 years. The surgical indication was a cardiomyopathy in terminal evolutive phase, of which the etiology was ischemia in 8 cases, congestion in 5 cases and rheumatism in one case. There was one operative death (7.1%) from acute rejection and a late death secondary to chronic rejection. The actuarial rate of survival at one and 2 years was 81.9%. Post-operative complications, most frequent at an early stage, were arterial hypertension (9 cases), rejection (8 cases) and renal insufficiency (6 cases). During an average post-operative evolution of 13 months, 17 rejection episodes occurred in 10 patients (71.4%) and 5 patients (35.7%) presented with 7 infectious episodes, one of them severe. Cyclosporin's toxicity appeared in the immediate post-operative period by an always reversible increase of the bilirubin and creatinin levels. On a long term, all patients present with arterial hypertension, accompanied by a moderate renal insufficiency (creatinin between 2.2 and 2.4 mg%). Among the survivors, 9 patients (75%) remain completely asymptomatic and have resumed normal physical activities. Cardiac transplantation has therefore become a valid therapeutic alternative, able to greatly improve survival and the functional condition of patients with terminal cardiomyopathy.
D000293:Adolescent; D000328:Adult; D009202:Cardiomyopathies / Q000601:surgery*; D005260:Female; D006084:Graft Rejection; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality; D013997:Time Factors
L'alternative chirurgicale dans le traitement des cardiomyopathies terminales: la transplantation cardiaque.