Outcomes With an Alternate List Strategy for Heart Transplantation

Felker, G. Michael; Milano, Carmelo A.; Yager, Jonathan E.E.; Hernandez, Adrian F.; Blue, Laura; Higginbotham, Michael B.; Lodge, Andrew J.; Russell, Stuart D.

doi:10.1016/j.healun.2005.03.014

Cited by 78 publications

(57 citation statements)

References 14 publications

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“…AL heart transplantation is a strategy designed to offer marginal donor hearts to recipients who do not meet conventional criteria for heart transplantation. 2,5 The AL heart transplants at our institution displayed a variety of recipient and donor organ characteristics. The most common recipient characteristic was advanced age.…”

Section: Discussionmentioning

confidence: 99%

“…Both groups experienced a similar incidence of significant rejection, but overall mortality was higher in the AL HT group. 2 The incidence of PGD did not differ between AL and SL HT recipients. Pre-transplant VAD and prolonged total ischemic times (Ն4.5hours) were independent predictors of PGD.…”

mentioning

confidence: 86%

“…We recently reported reduced intermediate survival for recipients on the alternate list versus the standard list. 2 In this report, we examine the incidence of PGD for standard list (SL) versus alternate list (AL) transplantation. We sought to determine whether the AL strategy was an independent predictor of PGD by examining factors felt to influence early graft function in a multivariate analysis.…”

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confidence: 99%

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Marginal Cardiac Allografts Do Not Have Increased Primary Graft Dysfunction in Alternate List Transplantation

et al. 2006

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Background-Clinical success with modern heart transplantation (HT) has led to the development of an alternate list (AL) HT strategy, matching marginal cardiac allografts with recipients who do not meet standard criteria for HT. Marginal allografts may be at an increased risk for primary graft dysfunction (PGD), the leading cause of early mortality after HT. 1 The incidence of PGD in AL HT relative to standard list (SL) HT has not been evaluated, and may contribute to the greater mortality associated with AL HT.2 The objective of this study was to determine the incidence of and predictors for PGD. Methods and Results-A retrospective analysis was performed on 260 consecutive adult patients undergoing either SL HT (nϭ207) or AL HT (nϭ53) at our institution from 1/2000 to 1/2005. PGD was defined by requirement for mechanical circulatory support immediately post-HT or more broadly as the need for either mechanical support or high-dose inotrope (epinephrine Ն0.07 g/kg/min). Donor hearts allocated to AL recipients were turned down for SL HT for reasons that included coronary disease, left ventricular dysfunction or hypertrophy, and high-dose inotropic requirement. AL HT recipients were significantly older, with a higher proportion of diabetes mellitus and ischemic cardiomyopathy. Both groups experienced a similar incidence of significant rejection, but overall mortality was higher in the AL HT group. 2 The incidence of PGD did not differ between AL and SL HT recipients. Pre-transplant VAD and prolonged total ischemic times (Ն4.5hours) were independent predictors of PGD. Conclusion-Select

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Section: Discussionmentioning

confidence: 99%

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confidence: 86%

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confidence: 99%

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Marginal Cardiac Allografts Do Not Have Increased Primary Graft Dysfunction in Alternate List Transplantation

et al. 2006

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“…Although the use of alternative criteria is associated with higher morbidity and mortality rates, it improves overall survival rates when compared with the natural history of end-stage heart failure and of destination LV assistance. 12 In conclusion, our experience shows that expanding heart-donor criteria to include otherwise healthy hearts with aortic valve pathologic conditions is feasible. However, these donor hearts must be evaluated…”

Section: Discussionmentioning

confidence: 80%

Bioprosthetic Aortic Valve Replacement in a Donor Heart before Orthotopic Heart Transplantation

Patel¹,

Vahdat²,

Nathan³

et al. 2017

Texas Heart Institute Journal

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T he strict criteria that define a heart ideal for transplantation have contributed to the severe shortage of donor organs. A large fraction of patients on the heart-transplant waiting list never receive one. This issue is exacerbated by the fact that one-year mortality rates without transplantation are 8.1%, 10.1%, and 14% for patients listed as United Network for Organ Sharing status 2, 1B, and 1A, respectively.1 Historically, surgeons have used "non-ideal" donor hearts that do not meet all donor criteria. 2 The fact is that recent technical advances can support the relaxation of donor-heart criteria in certain circumstances. We report a successful instance of orthotopic heart transplantation (OHT) performed with concurrent bioprosthetic aortic valve replacement (AVR). Case ReportThe patient was a 71-year-old man with a history of type 2 diabetes mellitus, hypertension, 5-vessel coronary artery bypass grafting, paroxysmal ventricular tachycardia (VT), and the implantation of a cardioverter-defibrillator/biventricular pacemaker. He was admitted to our hospital for symptomatic recurrent VT and heart failure. Initially, right-and left-sided heart catheterization showed severely diminished left ventricular (LV) function with cardiac output of 2.3 L/min, elevated filling pressures, increased pulmonary artery pressure (74/46 mmHg), and diffuse coronary artery disease not amenable to repeat revascularization.Because of the advanced heart failure and very high-risk nature of the alternative VT ablation, the patient was presented to the cardiac transplantation medical review board at our institution, where he was assigned 1A status for OHT. Until the donor heart became available, he was hospitalized for 51 days on intra-aortic balloon pump support with bumetanide, lidocaine, and procainamide drips.A transthoracic echocardiographic report on the donor heart showed moderate aortic valve regurgitation. We discussed this finding with the patient and his family,

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“…Despite the excellent outcomes that have been obtained with cardiac transplant, its impact on the heart failure epidemic is modest, primarily due to the supply of donor organs, which has limited the number of transplants to approximately 2000 annually in the United States. Although a variety of strategies to increase the number of available donor organs have been proposed or attempted [9,10], the number of cardiac transplants performed annually appears unlikely to change dramatically.…”

Section: Cardiac Transplantationmentioning

confidence: 99%

Advances in the surgical treatment of heart failure

Allen

Felker

2008

Current Opinion in Cardiology

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Purpose of review-Despite advancements in medical therapy, morbidity and mortality remain high. Surgical treatment of heart failure has been the subject of renewed focus, with a particular emphasis on applying the principles of evidence-based medicine to the evaluation of surgical therapies. The purpose of this review is to discuss emerging surgical therapies in heart failure, in particular, mechanical cardiac support and mitral valve repair.

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Outcomes With an Alternate List Strategy for Heart Transplantation

Cited by 78 publications

References 14 publications

Marginal Cardiac Allografts Do Not Have Increased Primary Graft Dysfunction in Alternate List Transplantation

Marginal Cardiac Allografts Do Not Have Increased Primary Graft Dysfunction in Alternate List Transplantation

Bioprosthetic Aortic Valve Replacement in a Donor Heart before Orthotopic Heart Transplantation

Advances in the surgical treatment of heart failure

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