Heart 1998;80:473-478 ( November )
Role of orthotopic heart transplantation in the management of patients with recurrent ventricular tachyarrhythmias following myocardial infarction
a University Department of Cardiology, Freeman
Hospital, Freeman Road, Newcastle upon Tyne NE7 7DN, UK, b Department of
Cardiothoracic Surgery, Freeman Hospital
Correspondence to: Dr Bourke. email: j.p.bourke{at}ncl.ac.uk
Accepted for publication 15 July 1998
Objective
To report the outcome of an intention to
treat by heart transplantation strategy in two groups of patients after
infarction, one with both left ventricular failure (LVF) and
ventricular tachyarrhythmias (VTA) (group A) and the other with
progressive LVF following antiarrhythmic surgery for VTA (group B).
Patients and methodsGroup A comprised 17 consecutive patients for whom transplantation was considered the best
primary non-pharmacological treatment; group B comprised five
consecutive patients assessed and planned for transplantation after
antiarrhythmic surgery.
ResultsIn group A, eight patients
underwent transplantation and all survived the first 30 day period. At
median follow up of 55 months (range 11 to 109) seven of this subgroup
were still alive. Five patients died of recurrent VTA before
transplantation, despite circulatory support. In the face of
uncontrollable VTA, four of these underwent "high risk"
antiarrhythmic surgery while awaiting transplantation: three died of
LVF within 30 days and one was saved by heart transplantation two days
after arrhythmia surgery. Mortality for the transplantation strategy in
group A patients was 47% by intention to treat analysis. Quality of
life in the eight actually transplanted, however, was good and only one
died during median follow up of 56 months. The five patients in group B
were accepted for transplantation for progressive LVF at a median of 21 months (range 12 to 28) after antiarrhythmic surgery. One died of LVF
before transplantation, 22 months after initial surgery; another died
of high output LVF three days after transplantation. Thus mortality of
the intended strategy was 40%. The three transplanted patients are
alive and well at 8-86 months.
ConclusionsAlthough the short and medium term
outcome in category A or B patients who undergo transplantation is
good, the overall success of the transplantation strategy in category A
patients is limited by lack of donors in the short time frame in which
they are required.
© 1998 by Heart
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Bourke, J. P., Gray, J., Hilton, C. J., Furniss, S. S., Khan, S., McComb, J. M., Campbell, R. W.F.
(1999). Identifying patients at low risk of death from cardiac failure after operation for postinfarct ventricular tachycardia. Ann. Thorac. Surg.
67: 404-410
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