Heart transplantation as a treatment for advanced heart failure

Background: Heart transplantation currently provides the most effective treatment for advanced heart failure. However, medical therapy for this condition has also improved, heart donors are scarce and the cost of the procedure is high. Therefore the indications and management of these patients need reevaluation. Aim: To analyze the results of 24 patients submitted to heart transplantation for end-stage hart failure needing repeated hospitalizations and i.v. inotropes for compensation. Patients and methods: The group was comprised by 21 men and 3 women with a mean age of 36.8 years, mean left ventricular ejection fraction 19+/-4.5%, mean systolic pulmonary artery pressure 48+/-13 mmHg (24-70) and mean pulmonary vascular resistance 2.6 Wood Units (1-5). Fourteen patients (58%) had a previous median sternotomy. Immunosupression did not include induction therapy and steroids were discontinued early. Results: Operative mortality was 4% at 30 days. Actuarial survival at one year was 90% and at 5 years 72%. Freedom from rejection at one year was 70% at one year and 56.5% at five years. All patients with more than 3 months of follow-up were in functional class I. Conclusions: These results justify the proposed modifications for transplantation protocols.