Better together: a reappraisal of heterotopic heart transplantation.
biologic ventricular assist
cardiac transplantation
heterotopic
pulmonary hypertension
transplant survival
Journal
Transplant international : official journal of the European Society for Organ Transplantation
ISSN: 1432-2277
Titre abrégé: Transpl Int
Pays: Switzerland
ID NLM: 8908516
Informations de publication
Date de publication:
Nov 2021
Nov 2021
Historique:
revised:
23
08
2021
received:
04
02
2021
accepted:
03
09
2021
pubmed:
26
9
2021
medline:
15
12
2021
entrez:
25
9
2021
Statut:
ppublish
Résumé
Heterotopic heart transplantation (HHT) is rare in the modern era. When used as a biologic left ventricular assist, HHT provides pulsatile flow, supports the left ventricle with a physiologic cardiac output, responds to humoral stimuli, and with modern immunosuppression may offer long-term untethered survival. This study was undertaken to compare survival of HHT with orthotopic heart transplantation (OHT) to assess its viability in the modern era. In the United Network for Organ Sharing database, from January 1999 to December 2020, there were 27691 bicaval OHT, 13836 biatrial OHT, 1271 total OHT, and 51 HHT with sufficient follow-up. Survival was analyzed using restricted mean survival time (RMST) through 4 years as the outcome. In the first 4 years after transplant, compared with HHT, differences in RMST were 0.1 years (99% CI: -0.4 to 0.5 years) for bicaval OHT, 0.0 years (99% CI: -0.4 to 0.5 years) for biatrial OHT, and 0.0 years (99% CI: -0.5 to 0.4 years) for total OHT. In this cohort, survival was indistinguishable between HHT and OHT recipients in the first four years. Thus, HHT might be a viable alternative to durable mechanical circulatory assist particularly with size mismatched grafts or for patients with refractory pulmonary hypertension.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2184-2191Subventions
Organisme : NIH HHS
ID : T32 HL-105324
Pays : United States
Organisme : NIH HHS
ID : 1K08GM138812-01
Pays : United States
Informations de copyright
© 2021 Steunstichting ESOT. Published by John Wiley & Sons Ltd.
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