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Ann Thorac Surg 1985;39:149-154
© 1985 The Society of Thoracic Surgeons

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Articles

Further Cardiac Transplant Procedures in Patients with Heterotopic Heart Transplants

From the Department of Cardiothoracic Surgery, Groote Schuur Hospital and the University of Cape Town Medical School, Cape Town, South Africa

Accepted for publication May 10, 1984.

^* Address reprint requests to Dr. Novitzky, Department of Cardiothoracic Surgery, University of Cape Town Medical School, Observatory 7925, Cape Town, South Africa

Seven patients with heterotopic heart transplants have undergone further heart transplant procedures. In 5, the first heterotopically placed donor heart was excised and replaced with the second donor heart. In 2, the first heterotopic donor heart was left in situ and the patient's own heart (then nonfunctioning) was excised and replaced by the second donor heart; thus, these patients underwent orthotopic transplantation and were left with two donor hearts. The decision to perform retransplantation in a patient undergoing irreversible acute rejection is usually straightforward, but the timing of a further transplant procedure in a patient with advanced graft arteriosclerosis may present a difficult problem. Two of the 7 patients in this series died of infectious complications within the first 3 months after retransplantation. A third patient acutely rejected the second donor heart within 5 days, but survived an additional 17 months with the support of his own cardiomyopathic heart. Four patients remain alive and well between 5 and 36 months following the second transplant and between 17 and 54 months following the first transplant procedure.

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