title: [Clinical experience with 53 consecutive heart transplants].
abstract: BACKGROUND
  Heart transplantation is the therapy of choice for advance heart failure. Our group developed two transplant programs at Instituto Nacional del Tórax and Clínica Dávila. We report our clinical experience based on distinctive clinical policies.
  
  
  METHODS
  Fifty-three consecutive patients were transplanted between November 2008 and April 2013, representing 51% of all Chilean cases. Distinctive clinical policies include intensive donor management, generic immunosuppression and VAD (ventricular assist devices) insertion.
  
  
  RESULTS
  Ischemic or dilated cardiomyopathy were the main indications (23 (43%) each), age 48 ± 13 years and 48 (91%) were male. Transplant listing Status: IA 14 (26%) (VAD or 2 inotropes), IB 14 (26%) (1 inotrope) and II25 (47%) (no inotrope). Mean waiting time 70 ± 83 days. Twelve (24%) were transplanted during VAD support (median support: 36 days).
  
  
  METHODS
  orthotopic bicaval transplant with ischemia time: 175 ± 54 min. Operative mortality: 3 (6%), all due to right ventricular failure. Re-exploration for bleeding 2 (4%), stroke 3 (6%), mediastinitis 0 (0%), pneumonia 4 (8%), and transient dialysis 6 (11%). Mean follow-up was 21 ± 14 months. Three-year survival was 86 ± 6%. One patient died of Pneumocystis jirovecii pneumonia and the other died suddenly (non-compliance). Freedom from rejection requiring specific therapy was 80 ± 7% at 3 years of follow-up. Four hundred eighty four endomyocardial biopsies were done: 11 (2.3%) had 2R rejection. All survivors are in NYHA (New York Heart Association) functional class I and all but one have normal biventricular function.
  
  
  CONCLUSIONS
  Mid-term results are similar to those reported by the registry of the International Society for Heart and Lung Transplantation. This experience has a higher proportion of VAD support than previous national series. Rejection rates are low in spite of generic immunosuppression.
authors.forename: Mauricio
authors.initials: M
authors.lastname: Villavicencio
authors.forename: Víctor
authors.initials: V
authors.lastname: Rossel
authors.forename: Ricardo
authors.initials: R
authors.lastname: Larrea
authors.forename: Juan Pablo
authors.initials: JP
authors.lastname: Peralta
authors.forename: Ernesto
authors.initials: E
authors.lastname: Larraín
authors.forename: Jong
authors.initials: J
authors.lastname: Sung Lim
authors.forename: Pamela
authors.initials: P
authors.lastname: Rojo
authors.forename: Francesca
authors.initials: F
authors.lastname: Gajardo
authors.forename: Erika
authors.initials: E
authors.lastname: Donoso
authors.forename: Margarita
authors.initials: M
authors.lastname: Hurtado
mesh_terms: D000328:Adult; D002311:Cardiomyopathy, Dilated / Q000453:epidemiology / Q000601:surgery; D002677:Chile / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006333:Heart Failure / Q000453:epidemiology / Q000601:surgery*; D016027:Heart Transplantation / Q000401:mortality / Q000706:statistics & numerical data*; D006353:Heart-Assist Devices / Q000706:statistics & numerical data; D006801:Humans; D007165:Immunosuppression Therapy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D012042:Registries; D012189:Retrospective Studies; D014019:Tissue Donors