title: Cardiac transplantation for hypertrophic cardiomyopathy: a valid therapeutic option.
abstract: BACKGROUND
  Hypertrophic cardiomyopathy is a rare indication for cardiac transplantation, with only anecdotal reports in the literature. Transplantation has been proposed to patients with hypertrophic cardiomyopathy who remained symptomatic despite optimal medical treatment or who progressed to congestive heart failure, and when conventional surgical correction was not or was no longer possible. In this report, we analyze the clinical results of cardiac transplantation in these patients.
  
  
  METHODS
  We retrospectively reviewed complete clinical data and prospectively gathered complete follow-up data for 14 patients who underwent orthotopic cardiac transplantation for hypertrophic cardiomyopathy at the Montreal Heart Institute and Ste-Justine Hospital between 1984 and 2001.
  
  
  RESULTS
  Ten male (71.4%, 5 adults and 5 children) and 4 female (28.6%, 2 adults and 2 children) patients underwent heart transplantation for hypertrophic cardiomyopathy. The median age of the recipients in the pediatric group was 13 years (range, 6-16) and was 40 years (range, 22-46) in the adult group. Median duration of follow-up was 9.5 years (mean, 8.8 +/- 4.8 years; range, 1-18) and was 100% complete. We found no operative mortality and found 2 late deaths related to coronary graft atherosclerosis. Long-term survival at 5, 10, and 15 years was 100%, 85%, and 64%, respectively. Freedom from acute rejection at 1, 5, and 10 years was 73%, 32%, and 9%, respectively. The remaining 11 survivors exhibit few symptoms and are currently in New York Heart Association Class I or II.
  
  
  CONCLUSIONS
  Cardiac transplantation is a valid therapeutic option for patients with symptomatic hypertrophic cardiomyopathy who do not respond to optimal medical management and who are not candidates for conventional surgical treatment. The long-term outcome is excellent in these patients.
authors.affiliation: Montreal Heart Institute, Research Center and Cardiovascular Division, Montreal, Quebec, Canada.
authors.forename: Marianne
authors.initials: M
authors.lastname: Coutu
authors.forename: Louis P
authors.initials: LP
authors.lastname: Perrault
authors.forename: Michel
authors.initials: M
authors.lastname: White
authors.forename: Guy B
authors.initials: GB
authors.lastname: Pelletier
authors.forename: Normand
authors.initials: N
authors.lastname: Racine
authors.forename: Nancy C
authors.initials: NC
authors.lastname: Poirier
authors.forename: Michel
authors.initials: M
authors.lastname: Carrier
mesh_terms: D000206:Actuarial Analysis; D000293:Adolescent; D000328:Adult; D002312:Cardiomyopathy, Hypertrophic / Q000401:mortality / Q000601:surgery*; D002648:Child; D003324:Coronary Artery Disease / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D016027:Heart Transplantation; D006801:Humans; D007165:Immunosuppression Therapy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome