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Francesco Musumeci
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Magdi H. Yacoub
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Ann Thorac Surg 1992;54:333-337
© 1992 The Society of Thoracic Surgeons

Articles

Heterotopic heart transplantation and recipient heart operation in ischemic heart disease

Paul D. Ridley, FRCS*, Asghar Khaghani, FRCS, Francesco Musumeci, MD, Roberto Favaloro, MD, El-Sayed Akl, MD, Nick R. Banner, MRCP, Andrew G. Mitchell, MRCP, Magdi H. Yacoub, FRCS

Departments of Cardiothoracic Surgery and Cardiology, Harefield Hospital, Harefield, Middlesex, England

Accepted for publication January 23, 1992.

* Address reprint requests to Mr Ridley, 19 Allander Rd, Milngavie, Glasgow, Scotland G62 8PN.

The role of heterotopic heart transplantation in coronary heart disease has not been defined. Between 1983 and 1988, 28 patients with end-stage ischemic heart disease were managed by heterotopic heart transplantation and adjunctive operation on the recipient heart: coronary artery bypass grafts and aneurysmectomy, 20; coronary artery bypass grafts, 5; and aneurysmectomy, 3. Indications were feasibility of operative procedures to the recipient heart and small donor size (61% of the donors were < 15 years). The 1-year and 5-year actuarial survival was 79% and 63%. Of the 22 patients who survived to 2-year follow-up, all of whom had been severely limited (New York Heart Association grade III/IV) preoperatively, 20 were in grades I or II at 2-year follow-up (p < 0.001). In 14 of 22 patients (64%), the recipient heart augmented the donor cardiac output substantially, and in 4 the recipient heart supported the patient when the donor heart failed to eject. In conclusion, this series demonstrates the efficacy of heterotopic transplantation combined with operation to the recipient heart in the management of patients with end-stage ischemic heart disease.




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