|
|
Ann Surg. 1996 May; 223(5): 576–584. | PMCID: PMC1235185 |
Survival benefits of heart and lung transplantation. P Van Trigt, R D Davis, G S Shaeffer, J W Gaynor, K P Landolfo, M B Higginbotham, V Tapson, and R M Ungerleider Division of Cardiothoracic Surgery, Duke University Medical Center, Durham, North Carolina 27710, USA. Abstract OBJECTIVE: Heart and lung transplantation has gained acceptance as therapy for end-stage cardiac and pulmonary failure. The early and intermediate survival benefits of one center's 10-year experience with 177 patients undergoing thoracic transplantation were examined. SUMMARY BACKGROUND DATA: As experience in cardiac and pulmonary transplantation has increased, improvements in patient selection, organ preservation, preoperative support, and perioperative care have significantly reduced the early threats to patient survival. Graft dysfunction due to chronic rejection appears to be the main risk for longer-term survival, and data compiled by the United Network for Organ Sharing (UNOS) indicate a 70% 5-year survival for heart transplants and a 50% 5-year survival for lung transplant recipients. METHODS: The medical records of 120 heart recipients, 52 lung transplant recipients, and 5 heart-lung recipients were reviewed. Cumulative survival estimates were made using Kaplan-Meier analysis. The etiologies of operative and long-term mortality in each transplant population were identified. A comparison of long-term survival after heart transplantation versus coronary revascularization in a group of patients with ischemic cardiomyopathy was performed. RESULTS: Operative mortality in both the cardiac and pulmonary transplant recipients was 8%. From 1990 to 1995, 70 consecutive adult cardiac transplant procedures were performed without an operative mortality. Three of five patients survived heart-lung transplantation. The extended actuarial survival rate at 5 years was 80% for the cardiac transplant recipients. The 2-year actuarial survival rate for the lung transplant recipients was 88%. Graft dysfunction was the most common cause of operative mortality in the heart transplant group whereas infection was responsible for most of the operative mortality after lung transplantation. CONCLUSIONS: Cardiac and pulmonary transplantation can be applied to morbidly ill patients with excellent operative and intermediate-term survival. Full text Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (1.5M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References. These references are in PubMed. This may not be the complete list of references from this article. - Frazier OH, Rose EA, Macmanus Q, Burton NA, Lefrak EA, Poirier VL, Dasse KA. Multicenter clinical evaluation of the HeartMate 1000 IP left ventricular assist device. Ann Thorac Surg. 1992 Jun;53(6):1080–1090. [PubMed]
- O'Connell JB, Bourge RC, Costanzo-Nordin MR, Driscoll DJ, Morgan JP, Rose EA, Uretsky BF. Cardiac transplantation: recipient selection, donor procurement, and medical follow-up. A statement for health professionals from the Committee on Cardiac Transplantation of the Council on Clinical Cardiology, American Heart Association. Circulation. 1992 Sep;86(3):1061–1079. [PubMed]
- Kenny J, Plappert T, Doubilet P, Salzman D, Sutton MG. Effects of heart rate on ventricular size, stroke volume, and output in the normal human fetus: a prospective Doppler echocardiographic study. Circulation. 1987 Jul;76(1):52–58. [PubMed]
- Davis RD, Jr, Pasque MK. Pulmonary transplantation. Ann Surg. 1995 Jan;221(1):14–28. [PubMed]
- Sarris GE, Moore KA, Schroeder JS, Hunt SA, Fowler MB, Valantine HB, Vagelos RH, Billingham ME, Oyer PE, Stinson EB, et al. Cardiac transplantation: the Stanford experience in the cyclosporine era. J Thorac Cardiovasc Surg. 1994 Aug;108(2):240–252. [PubMed]
- Lowe JE, Anstadt MP, Van Trigt P, Smith PK, Hendry PJ, Plunkett MD, Anstadt GL. First successful bridge to cardiac transplantation using direct mechanical ventricular actuation. Ann Thorac Surg. 1991 Dec;52(6):1237–1245. [PubMed]
- Ott GY, Herschberger RE, Ratkovec RR, Norman D, Hosenpud JD, Cobanoglu A. Cardiac allografts from high-risk donors: excellent clinical results. Ann Thorac Surg. 1994 Jan;57(1):76–82. [PubMed]
- Martí V, Ballester M, Augé JM, Obrador D, Moya C, Caralps-Riera JM. Donor and recipient determinants of fatal and nonfatal cardiac dysfunction during the first week after orthotopic heart transplantation. Transplant Proc. 1992 Feb;24(1):16–19. [PubMed]
- Sundaresan S, Trulock EP, Mohanakumar T, Cooper JD, Patterson GA. Prevalence and outcome of bronchiolitis obliterans syndrome after lung transplantation. Washington University Lung Transplant Group. Ann Thorac Surg. 1995 Nov;60(5):1341–1347. [PubMed]
- Sundaresan S, Trachiotis GD, Aoe M, Patterson GA, Cooper JD. Donor lung procurement: assessment and operative technique. Ann Thorac Surg. 1993 Dec;56(6):1409–1413. [PubMed]
- Reitz BA, Wallwork JL, Hunt SA, Pennock JL, Billingham ME, Oyer PE, Stinson EB, Shumway NE. Heart-lung transplantation: successful therapy for patients with pulmonary vascular disease. N Engl J Med. 1982 Mar 11;306(10):557–564. [PubMed]
- Murali S, Uretsky BF, Reddy PS, Tokarczyk TR, Betschart AR. Reversibility of pulmonary hypertension in congestive heart failure patients evaluated for cardiac transplantation: comparative effects of various pharmacologic agents. Am Heart J. 1991 Nov;122(5):1375–1381. [PubMed]
- Keogh A, Macdonald P, Harvison A, Richens D, Mundy J, Spratt P. Initial steroid-free versus steroid-based maintenance therapy and steroid withdrawal after heart transplantation: two views of the steroid question. J Heart Lung Transplant. 1992 Mar–Apr;11(2 Pt 2):421–427. [PubMed]
- Berry GJ, Brunt EM, Chamberlain D, Hruban RH, Sibley RK, Stewart S, Tazelaar HD. A working formulation for the standardization of nomenclature in the diagnosis of heart and lung rejection: Lung Rejection Study Group. The International Society for Heart Transplantation. J Heart Transplant. 1990 Nov–Dec;9(6):593–601. [PubMed]
- Van Trigt P. Ischemic cardiomyopathy: the role of coronary artery bypass. Coron Artery Dis. 1993 Aug;4(8):707–712. [PubMed]
- Milano CA, White WD, Smith LR, Jones RH, Lowe JE, Smith PK, Van Trigt P., 3rd Coronary artery bypass in patients with severely depressed ventricular function. Ann Thorac Surg. 1993 Sep;56(3):487–493. [PubMed]
- Kobashigawa JA, Katznelson S, Laks H, Johnson JA, Yeatman L, Wang XM, Chia D, Terasaki PI, Sabad A, Cogert GA, et al. Effect of pravastatin on outcomes after cardiac transplantation. N Engl J Med. 1995 Sep 7;333(10):621–627. [PubMed]
- Valantine HA, Schroeder JS. Recent advances in cardiac transplantation. N Engl J Med. 1995 Sep 7;333(10):660–661. [PubMed]
- Cooper JD, Billingham M, Egan T, Hertz MI, Higenbottam T, Lynch J, Mauer J, Paradis I, Patterson GA, Smith C, et al. A working formulation for the standardization of nomenclature and for clinical staging of chronic dysfunction in lung allografts. International Society for Heart and Lung Transplantation. J Heart Lung Transplant. 1993 Sep–Oct;12(5):713–716. [PubMed]
|
See "