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Ann Thorac Surg 1993;55:876-882
© 1993 The Society of Thoracic Surgeons

Articles

High-risk cardiac operation: A viable alternative to heart transplantation

Maryl R. Johnson, MD*,a,b, Maria Rosa Costanzo-Nordin, MDa,b, Alain L. Heroux, MDa,b, Walter G. Kao, MDa,b, G.Martin Mullen, MDa,b, Roque Pifarré, MDa,b, Henry J. Sullivan, MDa,b

a Section of Cardiology, Department of Medicine, and Department of Thoracic and Cardiovascular Surgery, Loyola University of Chicago, Maywood, Illinois USA
b Hines Veterans Administration Hospital, Hines, Illinois USA

Accepted for publication July 15, 1992.

* Address reprint requests to Dr Johnson, Department of Medicine, Loyola University Medical Center, 2160 South First Ave, Maywood, IL 60153.

To determine if high-risk heart operation with circulatory support standby is an acceptable alternative to direct heart transplantation, we reviewed 21 patients who were accepted as heart transplant candidates but offered a heart operation because of the availability of circulatory support. Preoperative left ventricular ejection fraction was 0.25 ± 0.08 (mean ± standard deviation), and New York Heart Association functional class was 3.4 ± 0.7. The patients underwent 16 bypass graft operations, 4 mitral and 2 aortic valve replacements, and 4 defibrillator implantations (combined procedures in 5 patients). An intraaortic balloon pump was placed in 12 patients. One patient required biventricular assist device support but was weaned in 11 days. Twenty patients were discharged 14.8 ± 11.5 days postoperatively. One patient died 15 days postoperatively of amiodarone-induced respiratory failure, and 1 died suddenly 2 months postoperatively. At 10.5 ± 6 months postoperatively, 19 patients (90%) are alive. Mean functional class is 1.9 ± 0.9. None of the patients has undergone transplantation, but 2 are awaiting donor organs. We conclude that in selected heart transplant candidates high-risk heart operation is a viable alternative to direct heart transplantation.




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