Native heart complications after heterotopic heart transplantation: insight into the potential risk of left ventricular assist device.

Abstract

BACKGROUND:

In heterotopic heart transplantation, the donor heart is connected parallel to the recipient's diseased heart. Recipients continue to have risks, such as arrhythmia, thromboembolism, valvular heart disease, and ischemic heart disease which can develop in the native heart. It may serve as a clinical model to study long-term pathophysiologic processes in the native heart of patients with a left ventricular assist device.

METHOD:

We analyzed the prevalence of long-term complications related to the native heart in the heterotopic heart transplant and attempted to gain insight into the potential risk to a native heart after receiving a left ventricular assist device.

RESULTS:

Between December 1984 and December 1994, 16 patients (13 men, 3 women, ranging in age from 37 to 60 years) underwent heterotopic heart transplant at the University of Pittsburgh. The 1- and 5-year survival rate after the transplant was 81% and 44%, respectively. Actuarial freedom from complications related to the native heart after 1 year and 4 years was ventricular arrhythmia: 85%, 75%; ischemic disease: 85%, 64%; valvular disease: 100%, 88%; and thromboembolism: 85%, 58%. Of these complications, thromboembolism was not considered in determining actuarial freedom from complications because thromboembolism should be regarded as a device-related complication rather than as a native-heart-related complication for left ventricular assist device recipients. Consequently, actuarial freedom from all complications excluding thromboembolism was 70% after 1 year and 50% after 4 years. In addition, the hazard function curve remains constant up to 80 months after the operation without significant differences among the yearly ratios.

CONCLUSIONS:

This analysis suggests that cautious observation of the native heart's long-term performance is necessary for the left ventricular assist device recipient.

• Authors: O Tagusari, R L Kormos, A Kawai, K Yamazaki, S M Pham, B G Hattler, S Murali, B P Griffith
• Journal: The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation (J Heart Lung Transplant) Vol. 18 Issue 11 Pg. 1111-9 (Nov 1999) ISSN: 1053-2498 [Print] United States
• PMID: 10598735 (Publication Type: Comparative Study, Journal Article)

Topics

• Adult
• Cardiac Catheterization
• Female
• Heart Transplantation
• Heart-Assist Devices (adverse effects)
• Hemodynamics
• Humans
• Male
• Middle Aged
• Prevalence
• Prognosis
• Retrospective Studies
• Risk Factors
• Survival Rate
• Tachycardia, Ventricular (epidemiology, etiology, physiopathology)
• Thromboembolism (epidemiology, etiology, physiopathology)
• Transplantation, Heterotopic
• United States (epidemiology)