Author + information
- Received January 19, 1994
- Revision received April 27, 1994
- Accepted June 13, 1994
- Published online November 15, 1994.
- Walter Kao, MD FACC∗,
- Dan McGee, PhD,
- Youlian Liao, MD,
- Alain L. Heroux, MD,
- George M. Mullen, MD FACC,
- Maryl R. Johnson, MD FACC and
- Maria Rosa Costanzo, MD FACC
- ↵∗Present address and address for correspondence: Dr. Walter Kao, Rush-Presbyterian-St. Luke's Medical Center, Heart failure and Cardiac Transplant Program, 1725 West Harrison Street, Suits 439, Chicago, Illinois 60612.
Objectives. This study compared the survival of patients with heart failure who have waited > 6 months for heart transplantation with that of patients who undergo heart transplantation after a similarly prolonged waiting period.
Background. There are little data describing outcome in patients with severe heart failure who have waited for extended periods of time on the heart transplant waiting list.
Methods. Sixty-three consecutive patients who spent >6 months on the heart transplant waiting list were examined. Mean (± SD) age was 53 ± 9 years, mean left ventricular ejection fraction was 19 ± 6%, and all were taking digoxin and diuretic and vasodilator agents. Patients who underwent transplantation during the follow-up period were censored from the pretransplantation analysis, and their survival was examined as part of the posttransplantation phase of the study.
Results. Of the 63 original patients examined, 25 underwent transplantation, 10 during inotropic or mechanical circulatory support. The pretransplantation mortality rate was 6% at 6 months after the 6-month milestone on the waiting list, 12% at 12 months and 22% at 18 months. The posttransplantation mortality rate was 5% at 6 months, 10% at 12 months and 24% at 18 months. There were no differences in survival at any time between the two phases of the study.
Conclusions. Survival of patients who have survived >6 months on the heart transplant waiting list is generally good. Although heart transplantation did not appear to confer additional survival advantage over medical therapy, a large proportion of the patients who underwent transplantation were critically ill at the time of transplantation and would undoubtedly have died of progressive heart failure had they not undergone transplantation. We conclude that heart transplantation should still be considered a therapeutic alternative in patients with heart failure even after a prolonged waiting period on the heart transplant waiting list.
☆ This study was presented at the 65th Scientific Session of the American Heart Association, New Orleans, Louisiana. November 1992.
- Received January 19, 1994.
- Revision received April 27, 1994.
- Accepted June 13, 1994.