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Ann Thorac Surg 2001;72:318-319
© 2001 The Society of Thoracic Surgeons

Correspondence

Sparing of the native right ventricle for heart transplantation

Moisés Calderón-Abbo, MDa, César Villaseñor-Colín, MDa, Luis David Sánchez-Velázquez, MD, MSca a Department of Cardiac Surgery and Circulatory Support, La Raza Medical Center, Paseo de la Soledad 69, La Herradura, Estado de Mexico 53920, Mexico

e-mail: moisesc{at}infosel.net.mx

To the Editor

We read with interest the recent article by Elefteriades and collaborators [1] describing the sparing of the native right ventricle for heart transplant recipients with pulmonary hypertension. Their rationale for this innovative experimental technique was the observed clinical problems related to the presence of an enlarged, hypocontractile heart, arrhythmias, stroke and the potential for systemic emboli, and left lung compression. Regarding heart-lung transplantation, the authors mentioned the disadvantages of donor shortages and negative long-term results.

In Mexico, we have a large population of patients with end-stage heart disease and associated pulmonary hypertension from rheumatic cardiomyopathy. Despite our efforts to establish a solid heart-lung transplant program, the scarcity of adequate donor heart-lung blocks encouraged us to start performing "high-risk" heterotopic heart transplantations in patients with moderate to severe pulmonary vascular disease. Our results in 14 patients have been satisfactory [2]. There has been only a single event of uncomplicated systemic embolism and one early death as a result of refractory infectious pneumonia. We consider the procedure a safe alternative, and our results have encouraged us to extend our indications. We have successfully carried out transplantation in 2 patients with associated valve disease, by performing simultaneous mitral valve replacement of the native heart and heterotopic transplantation. One of these patients also had a previously implanted aortic valve prosthesis.

Despite the innovative technique of Elefteriades and co-workers and its feasibility, we agree with the invited commentary of Dr DiSesa regarding the potential for thrombus formation in the donor right ventricle, the probable change to an unphysiological spherical shape, and the possible complications related to long vascular connections [1]. In addition, most of the right ventricular complications observed during heart transplantation today can be successfully treated by such measures as mechanical assistance, prostaglandins, and inhaled nitric oxide.

We congratulate the authors for their fine surgical experimental work. However, long-term studies comparing this technique with conventional heterotopic transplantation are needed.

References

  1. Elefteriades J.A., Lovoulos C.J., Tellides G., et al. Right ventricle-sparing heart transplant: promising new technique for recipients with pulmonary hypertension. Ann Thorac Surg 2000;69:1858-1864.
  2. Calderón M., Martinez E., Bonilla L.C., et al. Transplante cardiaco heterotópico de alto riesgo. Rev Mex Cardiol 1996;7:96-99.




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