title: Long-term results of heart transplantation for end-stage valvular heart disease.
abstract: BACKGROUND
  In general, heart transplantation for patients with heart failure improves survival. However, the outcomes of heart transplantation for patients with end-stage valvular heart disease are less well reported. This is a substantial group of patients, many of whom have had previous cardiac surgery. They therefore may be considered a subgroup with a poor prognosis. This study reports on the outcomes of heart transplantation for patients with end-stage valvular heart disease.
  
  
  METHODS
  From March 1989 to December 2004, 75 consecutive adult heart transplantations were performed for end-stage valvular heart disease. Clinical characteristics were retrieved from a computerized database.
  
  
  RESULTS
  The early mortality risk in heart transplantation for end-stage valvular heart disease was 13%, compared to 8% for other indications (p = 0.12). The main causes of early death were rejection (20%) and right ventricular failure (20%). The total follow-up time was 415 patient-years. During the follow-up, another 23 patients died (55/1000 patient-years of late mortality rate), mostly due to infection (43%) and multiorgan failure (22%). Multivariable analysis demonstrated that increased waiting time to heart transplantation correlated with increased survival (HR = 0.998, p = 0.04). The survival at 1, 5, 10, and 15 years was 70%, 64%, 56%, and 46% compared to 78%, 68%, 53%, and 41% for other indications, respectively (p = 0.5).
  
  
  CONCLUSIONS
  The outcomes of heart transplantation for patients with end-stage valvular heart disease are similar to those for other patients. Apparently, the longer the waiting time to heart transplantation the better the outcome becomes.
authors.affiliation: Julius Center for Health Sciences & Primary Care, University Medical Center Utrecht, The Netherlands. ystjang@hotmail.com
authors.forename: Yanto Sandy
authors.initials: YS
authors.lastname: Tjang
authors.forename: Geert J M G
authors.initials: GJ
authors.lastname: van der Heijden
authors.forename: Gero
authors.initials: G
authors.lastname: Tenderich
authors.forename: Reiner
authors.initials: R
authors.lastname: Körfer
authors.forename: Diederick E
authors.initials: DE
authors.lastname: Grobbee
mesh_terms: D016001:Confidence Intervals; D005260:Female; D006339:Heart Rate; D016027:Heart Transplantation / Q000401:mortality / Q000706:statistics & numerical data*; D006349:Heart Valve Diseases / Q000401:mortality / Q000601:surgery*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009426:Netherlands; D012189:Retrospective Studies; D012307:Risk Factors; D013223:Statistics as Topic; D013997:Time Factors; D016896:Treatment Outcome; D014850:Waiting Lists