ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
Investigation of factors affecting long-term survival in patients with heart transplantation
Mehmet Ali Özatik, Sinan Sabit Kocabeyoğlu, Mahmut Mustafa Ulaş, Ümit Kervan, İrfan Taşoğlu, Kerem Vural, Mustafa Paç, Şeref Küçüker
Türkiye Yüksek İhtisas Eğitim ve Araştırma Hastanesi Kalp ve Damar Cerrahisi Kliniği, Ankara
DOI : 10.5606/tgkdc.dergisi.2011.087
Background: In this study, risk factors affecting the morbidity and mortality of patients with orthotopic heart transplantation were evaluated and short- and long-term survival rates were investigated.

Methods: Orthotopic heart transplantation was performed in our clinic on 42 patients (36 males, 6 females; mean age 38.8±12 years; range 16 to 59 years) between May 1998 and December 2008. Surgery was conducted on 71.4% of patients for dilated cardiomyopathy. The biatrial cuff technique and bicaval technique were used for the orthotopic heart transplantation procedure in eight and 34 patients, respectively. Immunosuppression was maintained with cyclosporine, corticosteroids, and azathioprine in the first group of patients. After 2002, instead of azathioprine, mycophenolate mofetil became the third drug in the combination. Patients were followed up monthly during the first six-month period and for every three months afterwards. The mean follow-up period for all patients was 36 months. The patient with the longest follow-up period is in the 11th year.

Results: The cold ischemia time was 188.5±51.4 min. (range 85 to 250). Hospital mortality was seen in three patients (7.1%) whereas late mortality was seen in 11 (26.1%). The one-year, five-year, and 10-year survival rates were 80%, 66%, and 51%, respectively. The effects of cross-clamp time, donor gender, recipient gender, pulmonary artery pressure, preoperative ejection fraction, cold ischemia time and donor-recipient gender difference on early mortality and general survival were analyzed. These parameters were not statistically significant (p>0.05). All parameters, except donor age, had no effect on survival. The 10-year survival was 22% for the donor age group over 25 years old while it was calculated to be 75% for donor age group below 25 years of age (p=0.008).

Conclusion: Heart transplantation progresses parallel with medical and surgical developments; therefore, better early- and late-stage survival rates are obtained. Heart transplantation continues to be the gold standard in the treatment of end-stage heart disease.

Keywords : Heart transplantation; long-term follow-up; survival
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