PMID- 6752589
OWN - NLM
STAT- MEDLINE
DCOM- 19821218
LR  - 20071115
IS  - 0022-5223 (Print)
IS  - 0022-5223 (Linking)
VI  - 84
IP  - 5
DP  - 1982 Nov
TI  - Changes in indications for heart transplantation. An additional argument for the 
      preservation of the recipient's own heart.
PG  - 716-26
AB  - The 1 year survival rate after heart transplantation since 1967 from +/-30% to 
      +/-70%, and the 5 year survival rate is now +/-50%. This improvement has brought 
      renewed interest in this procedure, now done in about twenty centers in eight 
      countries, and increased confidence has widened the indication to patients who 
      are less than terminally ill, to restore quality of life. This trend is 
      illustrated by the Cape Town series, which can be divided into two parts: 10 
      patients treated by orthotopic heart transplantation (OHT), from 1967 to 1973, 
      and 40 patients treated by heterotopic heart transplantation (HHT), from 1974 to 
      1981. The HHT group was younger (mean 37 +/- 10 years versus 51 +/- 9 years, p 
      less than 0.001), had been ill for a shorter length of time (mean 3.6 +/- 0.7 
      years versus 6.6 +/- 1.4 years, p less than 0.091), and were in a lower New York 
      Heart Association (NYHA) class (mean 3.45 +/- 0.11 versus 3.9 +/- 1.0, p less 
      than 0.006). The improved survival is linked to patient selection, progress in 
      management, and switch to HHT, but not to progress in matching between donor and 
      recipient. Since there is no means to predict tolerance of the donor heart, HHT 
      limits the risks from unforseeable mismatch. The recipient's heart is a built-in 
      assist device, maintaining life when the donor heart fails acutely at operation 
      or during acute [three cases] or chronic [two cases] rejection. Had these 
      patients undergone OHT they would have died. Comparing the 10 oldest HHT patients 
      with the OHT series, no difference in pretransplant parameters was found. 
      However, survival of HHT recipients was longer during the critical post-HHT 
      period: at 3 months, p less than 0.011; at 6 months, p less than 0.05. Larger 
      series will separate the effects of progress in management from the intrinsic 
      advantages of HHT. Retaining the recipient's heart is logical and has brought few 
      complications. Survival rate of 40 HHT patients was 73% at 6, 65% at 12, and 51% 
      at 36 months; 85% of survivors are in NYHA Class I. In patients in less than 
      desperate condition, but who refuse to remain cripples, HHT eliminates the 
      growing ethical problem of removing a recipient's heart that may still support 
      the patient.
FAU - Losman, J G
AU  - Losman JG
FAU - Levine, H
AU  - Levine H
FAU - Campbell, C D
AU  - Campbell CD
FAU - Replogle, R L
AU  - Replogle RL
FAU - Hassoulas, J
AU  - Hassoulas J
FAU - Novitsky, D
AU  - Novitsky D
FAU - Cooper, D K
AU  - Cooper DK
FAU - Barnard, C N
AU  - Barnard CN
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - J Thorac Cardiovasc Surg
JT  - The Journal of thoracic and cardiovascular surgery
JID - 0376343
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Female
MH  - Follow-Up Studies
MH  - Graft Rejection
MH  - Heart/physiopathology
MH  - Heart Failure/surgery
MH  - *Heart Transplantation
MH  - Hemodynamics
MH  - Humans
MH  - Male
MH  - Methods
MH  - Middle Aged
EDAT- 1982/11/01 00:00
MHDA- 1982/11/01 00:01
CRDT- 1982/11/01 00:00
PHST- 1982/11/01 00:00 [pubmed]
PHST- 1982/11/01 00:01 [medline]
PHST- 1982/11/01 00:00 [entrez]
PST - ppublish
SO  - J Thorac Cardiovasc Surg. 1982 Nov;84(5):716-26.