Heart transplantation in patients with extreme right ventricular failure.
OBJECTIVE
Donor shortage and improved medical treatment of heart failure increase the prevalence of patients with extreme right ventricular failure and ascites to heart transplantation. The clinical outcome of heart transplantation in these patients has rarely been reported. Here, we sought to evaluate the clinical outcome of heart transplantation in patients with extreme right ventricular failure and refractory ascites.


METHODS
Data were collected by retrospective chart review.


RESULTS
Between 1993 and 2005, 12 patients with extreme right ventricular failure and refractory ascites underwent orthotopic heart transplantation at the authors' hospital. The causes of heart failure were congenital heart disease in four patients, dilated cardiomyopathy in two patients, rheumatic heart disease in two patients, coronary artery disease in two patients, and restrictive cardiomyopathy and transplant coronary artery disease each in one patient. Eight of 12 patients had previous cardiac operation. The findings of preoperative abdominal sonography were massive ascites in all patients, congestive liver in 11 patients, and probably cardiac cirrhosis in 1 patient. One patient underwent combined heart and kidney transplantations. There were six in-hospital deaths: bleeding in three patients and multiple organ failure in three patients. Major postoperative complications occurred in 10 patients: renal failure requiring dialysis in 9, bleeding requiring reoperation in 8 patients. Patients with previous cardiac operation had a higher mortality rate (5/7 vs 1/5).


CONCLUSIONS
Heart transplantation in patients with extreme right ventricular failure and refractory ascites was associated with high mortality and morbidity. The presence of previous cardiac operation implied even poor prognosis.
Hsu
Ron-Bin
RB
Department of Surgery, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan, ROC.
Lin
Fang-Yue
FY
Chou
Nai-Kuan
NK
Ko
Wen-Je
WJ
Chi
Nai-Hsin
NH
Wang
Shoei-Shen
SS
D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000601:surgery*; D016027:Heart Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D018497:Ventricular Dysfunction, Right / Q000209:etiology / Q000601:surgery*