Long-term results of heart transplantation for end-stage valvular heart disease.
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.
Tjang
Yanto Sandy
YS
Julius Center for Health Sciences & Primary Care, University Medical Center Utrecht, The Netherlands. ystjang@hotmail.com
van der Heijden
Geert J M G
GJ
Tenderich
Gero
G
Körfer
Reiner
R
Grobbee
Diederick E
DE
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