Three-Years Experience in Heart Transplantation

Several advances have occurred during the past two decades in the management of patients with end-stage heart disease. Cardiac transplantation is the best therapeutic modality to achieve long-term survival for these patients. Cardiac transplantation was performed in 18 patients (13 male and 5 female) during a three-year period. The mean age was 44.7±14.1 years (21-63 years). The etiology was idiopathic dilated cardiomyopathy in 10 patients, and ischemic cardiomyopathy in seven. Orthotopic cardiac transplantation was performed using the biatrial technique. The mean cardiac ischemia time was 170.7±61.7 minutes (101-335 min.). Triple-drug immunosuppression (cyclosporin A, prednisone, azathioprine) was given in all patients. Rejection was monitored by routine endomyocardial biopsy. All patients underwent annual coronary angiography.
RESULTS
Perioperative mortality was 11.1% with 2 deaths. Prolonged intubation was needed in 1 patient. Acute renal failure requiring dialysis was seen in 2 patients. One patient died from sepsis, 1 from hemophagocytic syndrome, 2 from aspergillus pneumonia, and 1 from staphylococcus pneumonia. All deaths were doserved within postoperative 6 months. Grade IIIA or greater rejection necessitating treatment was encountered in 7 patients.
CONCLUSION
Our preliminary results encourage us to continue transplantation practice. Close monitoring of rejection and infection is necessary in cardiac transplant patients.