[Heterotopic heart transplantation: 13-year experience at the Methodist Hospital of the Baylor Medical College].

Overview

UNLABELLED: In order to evaluate our experience in heterotopic cardiac transplantation, we conducted a retrospective analysis of the clinical files of patients who underwent this procedure. RESULTS: A total of 405 heart transplants were performed in our institution. In 24 (5.9%), the grafts were placed heterotopically. In group I (12 patients), the indication was irreversible pulmonary hypertension and in group II (remaining 12 patients), it was marginal grafts or size mismatch. Both groups demonstrated similar demographics and the survival rate was slightly better in group I. Nine patients from group I demonstrated an early reduction in pulmonary pressures which normalized in one year. CONCLUSIONS: The heterotopic heart supports the function of the native ventricles. In 9 patients, the heterotopic heart enables the reversal of a state of pulmonary hypertension previously thought to be irreversible. This finding supports the use of pulmonary vaso-dilators on a chronic basis or the use of a left ventricular assist device pre-transplant with the intention of normalizing pulmonary pressures and allowing the patients to become candidates for orthotopic cardiac transplantation and thereby avoiding the necessity of heterotopic cardiac transplantation.