>Year 2005, Issue 3
Archundia GA, Díaz G, González E, Pérez MJ, Vilchis R, Aceves JL
Cardiac transplantation program at the National Medical Center
Cir Gen 2005; 27 (3)
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Objective:To assess survival in patients subjected to cardiac transplantation as compared to those that received only medical treatment or some other surgical alternative.
Setting:Third level health care hospital.
Design: Retrospective, observational, comparative study.
Statistical analysis:The SPSS12.0 statistical software for Windows was used. Survival was determined by the Kaplan-Meier method and the qualitative variables by means of chi-square.
Patients and methods:We studied a cohort of patients admitted to our transplantation program between January 1987 and July 2001. We included 60 patients and divided them in three groups: Group 1, transplanted patients (n = 20); Group 2a, non-transplanted patients with a ‹ 20% ejection fraction (EF) (n = 20); Group 2b, non-transplanted patients with an EF › 20%, (n = 20). We recorded age, gender, etiology of the cardiopathy, EF, functional class (NYHA), return to working activity, time of cold ischemia of the transplanted organ, endocardiac biopsy findings, immunosuppressor scheme, date and cause of death. Survival was determined by the Kaplan-Meier method.
Results:There were no differences in the recorded variables among the studied groups. Survival in Group 1 patients was of 70 and 50% at 1 and 8 years, respectively; there were no survivors in group 2a at 1 year; in group 2b, survival was of 25% at 2 years (p ‹ 0.001). Transplanted patients remained in functional class I of NYHA, returning all of them to their social and working activities.
Conclusion:Cardiac transplantation, as treatment for end-stage cardiac failure remains to be better than medical management and than palliative surgical and technological procedures in terms of survival and quality of life.
||Cardiac transplantation, heart, survival.
Ranjit J, Hiranya H, Chen JM, Weinberg AD, Sinha PE, Itescu M. Impact of current management practices on early and late death in more than 500 consecutive cardiac transplant recipients. Ann Thorac Surg 2000; 232: 302-11.
Hunt SA. Current status of cardiac transplantation. JAMA 1998; 280: 1692-8.
Hunt SA, Schroeder JS, Billinham ME. Cardiac transplantation. In: Hurts JW, Schlant RC, Alexander RW: The Heart. 8º edition. McGraw Hill Editorial, Inc. Editorial 1994: 629-58.
Kirklin JK, Naftel DC, Bourge RC, McGiffin DC, Hill JA, Rodeheffer RJ. Evolving trends in risk profiles and causes of death after heart transplantation: A ten-year multi-institutional study. J Thorac Cardiovasc Surg 2003; 125: 881-90.
Bourge RC, Kirklin JK, Naftel DC, McGiffin DC. Predicting outcome after cardiac transplantations: lessons from the Cardiac Transplant Research Database. Curr Opin Cardiol 1997; 12: 136-45.
Smits JM, De Meester J, Deng MC, Scheld HH, Hummel M, Schoendube F. Mortality rates after heart transplantation: How to compare center-specific outcome data? Circulation 2003; 75: 90-6.
Ecochard R, De Gevigney G. Fair comparison of mortality data following cardiac surgery. Heart 2000; 84: 5-6.
Taylor OD, Edwards BL, Bouceck MM, Trulock PE, Keck MB, Hertz IM. The registry of the International Society for Heart and Lung Transplantation: 21th official adult transplant report. J Heart Lung Transplant 2004; 23: 796-803.
Bond A, Nelson K, Germany CL, Smart AN. The Left Ventricular Assist Device: A surgically implanted pump acts as a ‘bridge to transplantation’ for patients with heart failure. Also recently approved as long-term therapy, the LVAD may soon be used in thousands more patients. Am J Noursing 2003; 103: 32-40.
Arrowsmith J, Dunning J, Gray S, McNeil K, Meggs N, Parameshwar J, et al. Surgical management of severe heart failure with thoratech ventricular assist devices. Heart 2000; 83(Suppl I): 58.
Forster F, Kaufmann R, Reul H, Rau G. A small pulsatile blood pump for ventricular support during end-stage heart failure. Artificial Organs. 2000; 24: 373-37.
Camp D. The left ventricular assist device (LVAD): a bridge to heart transplantation. Crit Care Nurs Clin North Am 2000; 12: 61-8.
Christensen DM. The ventricular assist device: an overview. Nurs Clin North Am 2000; 35: 945-59.
Schmid C, Hammel D, Deng, Mario C, Weyand M, Baba HT, et al. Ambulatory care of patients with left ventricular assist devices. Circulation 2000; 100(Suppl II): 224-II-228.
Aaronson KD, Schwartz JS, Chen TM, Wong KL, Going JE, Mancini DM. Development and prospective validation of a clinical index to predictict survival in ambulatory patients referred for cardiac transplant evaluation. Circulation 1997; 95: 2660-7.
Mancini D, Eisen H, Kussmaul W, Mull R, Edmunds L, Wilson J. Value of peak exercise oxygen consumption for optimal timing of cardiac transplantation in ambulatory patients with heart failure. Circulation 1991; 83: 778-86.
Robert A. Introduction to the general evaluation of the patient. In: Hurts JW, Schlant RC, Alexander RW. The Heart . 8º edition. McGraw Hill, Inc. Editorial. 1994: 201-3.
Young JB. Cardiac transplantation. Curr Opinion Cardiol 2003; 18: 127-8.
Ventura HG, Muhammed K. Historical perspectives on cardiac transplantation: the past as prologue to challenges for the 21st century. Curr Opinion Cardiol 2001; 16: 118-23.
Tokarczyk TR. Cardiac transplantation as a treatment option for the heart failure patient. Crit Care Nurs Quarterly 2003; 26: 61-68.
Hosenpud JD, Bennett LE, Berkeley MK, Boucek MM, Novik JR, Keck BM, et al. The Registry of the International Society for Heart and Lung Transplantation: Seventeenth Official Report-2000. J Heart Lung Transplant 2000; 10: 909-31.
Bocci EA, Fiorelli A. The Brazilian experience with heart transplantation: a multicenter report. J Heart Lung Transplant 2002; 20: 637-45.
Palacios MJ, Palacios MA, Maulén RX, Martínez GE. Trasplante de corazón: experiencia en México. Cir Gen 1994; 16: 247-52.
Mullen JC, Bentley MJ, Modry DL, Koshai A. Extended donor ischemic times and recipient outcome after orthotopic cardiac transplantation. Can J Cardiol 2001; 17: 421-6.
Reiken S, Wehrens HT, Vest JA, Barbone A, Klotz S, Mancini D, et al. [beta]-Blockers restore calcium release channel function and improve cardiac muscle performance in human heart failure. Circulation 2003; 107: 2459-66.
Packer M, Colucci W, Sackner-Bernstein J, Liang Ch, Goldscher D, Freeman I, et al. Double-blind, placebo-controlled study of the effects of carvedilol in patients with moderate to severe heart failure: The precise trial. Circulation 1996; 94: 2793-9.
CIBIS-II. The Cardiac Insufficiency Bisoprolol Study II (CIBIS-II): a randomized trial. Lancet 1999; 353: 9-13.
Lowes BD, Gilbert EM, Abraham WT, Minobe WA, Larrabee PF, Debra W, et al. Myocardial gene expression in dilated cardiomyopathy treated with beta-blocking agents. N Engl J Med 2002; 346: 1357-65.
>Year 2005, Issue 3