Heterotopic Heart Transplantation in Argentina

Abstract

Purpose:The presence of irreversible pulmonary hypertension and/ or anthropometric significant differences between donor and recipient (> 20%) are one of the main constraints in the selection of suitable donors to enable the completion of a successful orthotopic heart transplant. The use of pretransplant ventricular assistance or the selection of heavier donors, and the heterotopic heart transplantation (HHTx) had been considered in different transplant programs to try to overcome this drawback and also as a bridge to recovery. We present here our experience in HHTx. Methods:In an attempt to address this issue we evaluate our experience in 11 HHTx performed at our institution between 2001 and 2013, in 10 patients [8 Males (73 %), 3 Females (27 %); Age 42.5 ± 15 years (18/65)]; one patient (Pts) received a second HHTx at 15 month post first HTxC. Pre transplant diagnosis were: idiopathic dilated cardiomyopathy 7 Pts (63.6%), necrotic dilated cardiomyopathy 1 Pts (9.1%), Chagas cardiomyopathy 1 Pts (9.1%), hypothyroid cardiomyopathy 1 Pts (9.1%) and graft vascular disease 1 Pts (9.1%). Three of the recipients were in national emergency waiting list at the time of transplantation, 2 in urgency and 6 in elective lists. The donor / recipient selection criteria was done taking in account significant high pulmonary vascular resistances and / or anthropometric mismatch, and/or sex mismatch. In all Pts the donor pulmonary artery was anastomosed to the recipient right atrium without the use of any prosthetic material to spare the donor right ventricle and assisting recipient's left ventricle using the recipient right ventricle to support the pulmonary circulation. Proper synchronization between the two hearts was performed using pacemakers. Ischemic times varied between 76 and 245 minutes (mean 184.1 ± 57.8). Standard immunosuppression scheme was used. Results: The actuarial survival including hospital mortality was 67% at one year and 56% at 5 years. The average follow-up of patients was 4.46 years, and longer survival reached is 13.6 years. All patients who survive more than 3 month returned to normal life. Conclusion: Several attempts to perform HHTx in our country failed using the conventional surgical technic. In our experience, applying the technic described by Yacoub and Khaghani, we consider that is feasible for a selected group of patients with acceptable medium term results.