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Ann Thorac Surg 1988;45:192-197
© 1988 The Society of Thoracic Surgeons

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Articles

The Changing Face of Cardiac Transplantation: The Washington University Program, 1985-1987

From the Division of Cardiothoracic Surgery, Department of Surgery; the Division of Cardiology, Department of Medicine; the Department of Anesthesia, and the Department of Pathology, Washington University School of Medicine, St. Louis, MO

Accepted for publication September 14, 1987.

^* Address reprint requests to Dr. Bolman, 3108 Queeny Tower, 4989 Barnes Hospital Plaza, St. Louis, MO 63110

Since January, 1985, 59 patients have undergone 62 heart transplantations at Washington University School of Medicine. The experience in this program serves as a useful microcosm of the field of cardiac transplantation as a whole to demonstrate certain trends that are becoming evident. Of the patients, 47% had coronary artery disease compared with 40% with cardiomyopathy. Fourteen patients (24%) were 55 years old or older at the time of transplantation. Sixteen patients (27%) required mechanical support of respiration or circulation or both prior to transplantation. Six patients were maintained with a left ventricular or biventricular assist device, and all survived; 1 patient received extracorporeal membrane oxygenation and lived; 7 patients were maintained with an intraaortic balloon pump, 6 of whom survived; and 2 were maintained with a mechanical ventilator and survived. The preoperative waiting period averaged 51 days for the group as a whole. Status-3 patients experienced an average 81-day waiting period, and those in blood group O waited 155 days. In contrast, critically ill patients (status 0) underwent transplantation within an average of 9 days. Actuarial survival at 12 months for all patients, operative survivors, patients age 55 years old or more, and patients bridged to transplantation was 87%, 92%, 84%, and 87%, respectively. Utilizing the combination therapy of cyclosporine, azathioprine, and prednisone introduced by one of us in 1983 and administered to all patients in this series, 50% of patients were rejection free and 56% were infection free at 12 months. There has been one case each of fatal infection and rejection. This series demonstrates that the patient with a low-priority status can expect to experience a prolonged preoperative waiting period. In contrast, the patient requiring heroic support preoperatively can expect to undergo transplantation more expeditiously. These data suggest that transplantation can be safely offered both to the desperately ill patient requiring mechanical support and to the patient in the latter half of the sixth decade of life.

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