Clinical evolution of heart transplantation in patients with previous valvular cardiomyopathy.
OBJECTIVE
Heart transplantation (HT) due to valvular cardiomyopathy is rare, namely, about 3% of cases in the Registry of the International Society for Heart and Lung Transplantation (ISHLT). Usually, these patients present some risk factors such as previous valvular operations and pulmonary hypertension. Since there are few studies in the literature, we retrospectively analyzed our early and long-term results.


METHODS
We studied our experience in 22 HT cases for valvular cardiomyopathy (9.3% of our total experience), namely, 12 men and 10 women, of overall mean age of 52.6 +/- 10 years. Five patients had mitral; 8, aortic; and 1, tricuspid valve disease; 7 had double valve disease and 1, triple valve disease. Nineteen patients (87%) had been operated previously between 1 and 4 times. The mean ejection fraction was 23% +/- 7.3% and the mean New York Heart Association (NYHA) functional class was 3.7. Fifty-three percent of the patients had pulmonary hypertension. Two patients were operated as an emergency "O." We used the standard HT technique.


RESULTS
Four patients (18%) were reoperated due to hemorrhage. The hospital mortality was 2 cases (9%). Another patients (9%) died on follow-up due to cardiac allograft vasculopathy. All surviving patients have been followed to the end of 2006. The mean follow-up has been 72 +/- 53 months. They are functional class I or II.


CONCLUSIONS
HT for this indication was more frequent in our experience than in the Registry of the ISHLT. The immediate and long-term results were good, with an 82% mean survival at 6 years. HT can be a good treatment for patients with valvular cardiomyopathy and bad ventricular function and/or multiple valvular reoperations.
Rotela Samaniego
J A
JA
Hospital Universitario de Bellvitge, University of Barcelona, IDIBELL, Barcelona, Spain.
Castells
E
E
Manito
N
N
Roca
J
J
Toscano
J
J
Calbet
J M
JM
Saura
E
E
Fontanillas
C
C
Benito
M
M
Granados
J
J
Miralles
A
A
Rabasa
J M
JM
Ortiz
D
D
Toral
D
D
Rullan
C
C
Ventura
J L
JL
Esplugas
E
E
D000328:Adult; D009202:Cardiomyopathies / Q000209:etiology* / Q000601:surgery; D005260:Female; D006334:Heart Function Tests; D016027:Heart Transplantation / Q000401:mortality / Q000502:physiology*; D006349:Heart Valve Diseases / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis; D017741:Survivors; D016896:Treatment Outcome