HEART-TRANSPLANTATION - CLINICAL-STUDY AND RESULTS OF THE FIRST 100 GRAFTS

Objectives: Global results of entire series of heart transplantations are essential to better evaluate survival rates. We therefore report the results of our first 100 transplantations. Methods: Orthotopic heart transplantation was performed in 82 men and 18 women (age 50.5 +/- 11.4; range 9-65). Sixteen were over 60. Primitive cardiomyopathies (n=51) and coronary artery disease (n=44) were the most frequent underlying diseases. Secondary morbidity was evaluated according to the international classification on the basis of pathological examination of endo-myocardial biopsies. Results: Immediate post-operative survival rate was 89 percent : there was 1 peroperative death, 7 deaths due to persistent pulmonary hypertension and 4 due to irreversible left ventricular failure. Eight deaths occurred during the 2nd and 3rd postoperative months for an overall early survival rate of 81 percent, After a mean follow-up of 2.4 years (maximum 6.16 yr), the actuarial survival rate at 5 years was 58 percent. Among the 470 biopsies performed, rejection was classified weak or null in 326, moderate in 125 and severe in 19. Pulmonary artery resistance, immunosuppression and, later, the risk of coronary artery disease and intrinsic graft changes were the three major problems encountered in this series. Conclusions: Despite its limits, heart transplantation remains an effective therapeutic option, particularly for young patients in good general health.