Heterotopic heart transplantation — a means to increase donor availability

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Abstract
From November 1985 to August 1989, 105 patients underwent hearttransplantation at our institution of whom 8 (7%) underwent heterotopicheart transplantation (HHTx). There were 7 males and 1 female with a meanage of 49 +/- 6 years (range, 41-58 years), 7 of whom had ischaemiccardiomyopathy and 1 had dilated cardiomyopathy. The indications for HHTxwere gross donor/recipient size mismatch, unreliable donor heart, elevatedpulmonary vascular resistance and the need for urgent transplantation ortheir combination. HHTx was performed as a left ventricular bypass in 6patients and as biventricular bypass in 2 combined with various surgicalprocedures on the native heart in 5. There was one perioperative death witha mean follow-up of the survivors of 17 +/- 10 months (range, 6-30 months).Comparison of preoperative and postoperative (1 year) 2-D echocardiographicstudies of the native heart showed haemodynamic stability of the latterwith no substantial changes in left ventricular ejection fraction andcardiac index, while left ventricular end- diastolic volume tended toincrease in 2 patients. In conclusion, preservation of the native heartallows recovery or growth of a graft considered unsuitable for orthotopictransplantation. Our experience confirms that HHTx may still be considereda valuable alternative to orthotopic transplantation in selected patients,thus expanding donor utilization.

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