Long-Term Results of Heart Transplantation for End-Stage Valvular Heart Disease |
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Authors: | Yanto Sandy Tjang,M.D.,M.P.H.,M.Sc.,D.Sc.,Ph.D.,F.I.C.S.,&dagger ,&Dagger ,Geert J. M. G. van der Heijden,Ph.D.,Gero Tenderich,M.D.,Ph.D.,&dagger ,Reiner Kö rfer,M.D.,Ph.D.,&dagger , Diederick E. Grobbee,M.D.,Ph.D.,&Dagger |
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Affiliation: | Julius Center for Health Sciences &Primary Care, University Medical Center Utrecht, The Netherlands;;Department of Thoracic &Cardiovascular Surgery, Heart &Diabetes Center NRW, Bad Oeynhausen, Germany;;and Netherlands Institutes for Health Sciences, Erasmus Medical Center Rotterdam, The Netherlands |
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Abstract: | Abstract Background: In general, heart transplantation for patients with heart failure improves survival. However, the outcomes of heart transplantation for patients with end-stage valvular heart disease are less well reported. This is a substantial group of patients, many of whom have had previous cardiac surgery. They therefore may be considered a subgroup with a poor prognosis. This study reports on the outcomes of heart transplantation for patients with end-stage valvular heart disease. Patients and methods: From March 1989 to December 2004, 75 consecutive adult heart transplantations were performed for end-stage valvular heart disease. Clinical characteristics were retrieved from a computerized database. Results: The early mortality risk in heart transplantation for end-stage valvular heart disease was 13%, compared to 8% for other indications (p = 0.12). The main causes of early death were rejection (20%) and right ventricular failure (20%). The total follow-up time was 415 patient-years. During the follow-up, another 23 patients died (55/1000 patient-years of late mortality rate), mostly due to infection (43%) and multiorgan failure (22%). Multivariable analysis demonstrated that increased waiting time to heart transplantation correlated with increased survival (HR = 0.998, p = 0.04). The survival at 1, 5, 10, and 15 years was 70%, 64%, 56%, and 46% compared to 78%, 68%, 53%, and 41% for other indications, respectively (p = 0.5). Conclusion: The outcomes of heart transplantation for patients with end-stage valvular heart disease are similar to those for other patients. Apparently, the longer the waiting time to heart transplantation the better the outcome becomes. |
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