ISSN : 1301-5680
e-ISSN : 2149-8156
TURKISH JOURNAL OF
THORACIC AND
CARDIOVASCULAR SURGERY
Turkish Journal of Thoracic and Cardiovascular Surgery     
12-YEAR KOŞUYOLU EXPERIENCE IN CARDIAC TRANSPLANTATION
Kaan KIRALİ, Denyan MANSUROĞLU, Suat Nail ÖMEROĞLU, Altuğ TUNCER, Ercan EREN, Mehmet Erdem TOKER, Hasan Basri ERDOĞAN, Murat Bülent RABUS, Vedat ERENTUĞ, Deniz GÖKSEDEF, Mustafa GÜLER, Bahadır DAĞLAR, Mehmet BALKANAY, Esat AKINCI, Gökhan İPEK, *Tuncer KOÇAK, **Turan BERKİ, ***Ali GÜRBÜZ, ****Ömer IŞIK, Cevat YAKUT
Koşuyolu Kalp Eğitim ve Araştırma Hastanesi, Kalp Damar Cerrahisi Kliniği, İstanbul
*Koşuyolu Kalp Eğitim ve Araştırma Hastanesi, Anesteziyoloji Kliniği, İstanbul
**Kocaeli Üniversitesi Tıp Fakültesi, Kalp Damar Cerrahisi Anabilim Dalı, Kocaeli
***İzmir Atatürk Devlet Hastanesi, Kalp Damar Cerrahisi Kliniği, İzmir
****Acıbadem Carousel Hastanesi, Kalp Damar Cerrahisi Bölümü, İstanbul
Background: Cardiac transplantation is the first alternative for the treatment of patients with end stage heart disease, which can not be treated medically or surgically. The aim of this study was to investigate early and late outcome of the patients undergone heart transplantation in our center.
Methods: Between September 1989, and April 2001, 18 patients underwent cardiac transplantation in Koşuyolu Heart and Research Hospital. Orthotopic cardiac transplantation was performed in 17 patients and heterotopic cardiac transplantation in one patient. There were 16 (88.9%) male and 2 (11.1%) female recipients with a mean age of 35 ± 11.5 years (range, 19 to 58 years). All patients had end-stage heart disease that was caused by an idiopathic dilated cardiomyopathy in 13 patients (72.2%), an ischemic cardiomyopathy in 3 patients (16.7%), a hypertropic cardiomyopathy in one patient (5.55%) and valvular heart disease in the last one (5.55%). Total cardiopulmonary bypass time was 131 ± 21.8 minutes (range, 105 to 166 minutes) and aortic cross clamp time was 62.3 ± 11.4 minutes (range, 48 to 80 minutes). Twelve patients (67.7%) were in NYHA class III, and six (33.3%) were in NYHA class IV. All patients were followed meanly 2.3 ± 1.7 years, and the longest follow-up was 7 years.
Results: Early mortality was observed only in one patient undergone heterotopic cardiac transplantation. There was no early mortality in the orthotopic group. Late mortality was 58.8% with 10 patients. The causes were infection in 4 patients, sudden death in 4 patients, and noncardiac in 2 patients. Actuarial survival was 94.4% ± 5.4% at 1 month, 83.3% ± 8.8% at 6 months, and 44.5% ± 12.7% at 3 years, respectively. Acute rejection was observed in 6 patients (35.3%) and was treated medically. Infection caused by different microorganisms developed in 10 patients (58.8%) during the follow-up period.
Conclusions: There are some problems in our country causing by social and cultural behaviors during the application of cardiac transplantation program. But, the main reason is the limited number of donors. Despite of the success in surgery and treatment of acute rejection, infection and give-up of immunosuppressive therapy are still major problems during long-term follow-up.
Keywords : Transplantation, donor, recipient, rejection, immunosupression
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