title: Heterotopic heart transplantation: the United States experience.
abstract: BACKGROUND
  More than 3 decades have passed since the first heterotopic heart transplantation (HHT) was reported. Nowadays, this surgical technique is used rarely, and only in patients who do not qualify for standard orthotopic heart transplantation (OHT). Current indications mainly comprise refractory pulmonary hypertension and a donor-recipient size mismatch (>20%). The objective of this study was to analyze the United States experience with HHT.
  
  
  METHODS
  The United Network for Organ Sharing (UNOS) database between 1987 and 2007 was analyzed. Patients who underwent heart transplantation were enrolled in this study. Patients with missing transplant dates or history of retransplantation were excluded.
  
  
  RESULTS
  A total of 41,379 patients underwent OHT and 178 HHT; 32,361 and 111 patients, respectively, were enrolled. Overall 1-, 5-, and 10-year survival was significantly (P < .001) better in OHT (87.7%, 74.4%, 54.4%) than HHT patients (83.8%, 59%, 35.1%). Survival in patients with transpulmonary gradients (TPG) >15 mmHg was 86.6 %, 73.3%, and 57.4% in the OHT and 93.8%, 64.8%, and 48.6% in the HHT group (P = .35). Pretransplant criteria (HHT versus OHT) with statistically significant differences (P < .05) were as follows (mean + SD): recipient weight, 78.9 + 19.9 versus 74.1 + 23.4 kg; recipient height, 174.9 + 13.9 versus 168 + 25.1 cm; and TPG 12.1 + 7.2 versus 9.6 + 6.3 mmHg.
  
  
  CONCLUSIONS
  The results show that HHT remains a feasible option in a highly selected patient population, with overall good results.
authors.affiliation: Department of Surgery, Division Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
authors.forename: Jama
authors.initials: J
authors.lastname: Jahanyar
authors.affiliation: Department of Medicine and Surgery, Heart and Vascular Institute, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA.
authors.forename: Michael M
authors.initials: MM
authors.lastname: Koerner
authors.affiliation: Department of Medicine and Surgery, Heart and Vascular Institute, Penn State Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA.
authors.forename: Ali
authors.initials: A
authors.lastname: Ghodsizad
authors.affiliation: Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX.
authors.forename: Matthias
authors.initials: M
authors.lastname: Loebe
authors.affiliation: Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX.
authors.forename: George P
authors.initials: GP
authors.lastname: Noon
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D018572:Disease-Free Survival; D005260:Female; D006084:Graft Rejection / Q000401:mortality*; D006333:Heart Failure / Q000401:mortality* / Q000601:surgery*; D016027:Heart Transplantation / Q000401:mortality* / Q000706:statistics & numerical data / Q000639:trends; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D017678:Sex Distribution; D015996:Survival Rate; D014019:Tissue Donors / Q000706:statistics & numerical data*; D066027:Transplant Recipients / Q000706:statistics & numerical data*; D016042:Transplantation, Heterotopic / Q000401:mortality / Q000706:statistics & numerical data / Q000639:trends; D014481:United States / Q000453:epidemiology; D055815:Young Adult