Experiencia clínica con 53 trasplantes cardiacos consecutivos

Introduction: Heart transplantation is the therapy of choice for advance heart failure. Our group developed two transplant programs at Instituto Nacional del Tórax and Clínica Dávila. We report our clinical experience based on distinctive clinical policies. Patients and Methods: Fifty-three consecut...

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Autores principales:	Villavicencio,Mauricio, Rossel,Víctor, Larrea,Ricardo, Peralta,Juan Pablo, Larraín,Ernesto, Sung Lim,Jong, Rojo,Pamela, Gajardo,Francesca, Donoso,Erika, Hurtado,Margarita
Lenguaje:	Spanish / Castilian
Publicado:	Sociedad Médica de Santiago 2013
Materias:	Cardiomyopathies Heart-assist devices Heart transplantation
Acceso en línea:	http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872013001200001
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spelling	oai:scielo:S0034-988720130012000012014-10-10Experiencia clínica con 53 trasplantes cardiacos consecutivosVillavicencio,MauricioRossel,VíctorLarrea,RicardoPeralta,Juan PabloLarraín,ErnestoSung Lim,JongRojo,PamelaGajardo,FrancescaDonoso,ErikaHurtado,Margarita Cardiomyopathies Heart-assist devices Heart transplantation Introduction: Heart transplantation is the therapy of choice for advance heart failure. Our group developed two transplant programs at Instituto Nacional del Tórax and Clínica Dávila. We report our clinical experience based on distinctive clinical policies. Patients and Methods: Fifty-three consecutive patients were transplanted between November 2008 and April 2013, representing 51% of all Chilean cases. Distinctive clinical policies include intensive donor management, generic immunosuppression and VAD (ventricular assist devices) insertion. Results: Ischemic or dilated cardiomyopathy were the main indications (23 (43%) each), age 48 ± 13 years and 48 (91%) were male. Transplant listing Status: IA 14 (26%) (VAD or 2 inotropes), IB 14 (26%) (1 inotrope) and II25 (47%) (no inotrope). Mean waiting time 70 ± 83 days. Twelve (24%) were transplanted during VAD support (median support: 36 days). Operative technique: orthotopic bicaval transplant with ischemia time: 175 ± 54 min. Operative mortality: 3 (6%), all due to right ventricular failure. Re-exploration for bleeding 2 (4%), stroke 3 (6%), mediastinitis 0 (0%), pneumonia 4 (8%), and transient dialysis 6 (11%). Mean follow-up was 21 ± 14 months. Three-year survival was 86 ± 6%. One patient died of Pneumocystis jirovecii pneumonia and the other died suddenly (non-compliance). Freedom from rejection requiring specific therapy was 80 ± 7% at 3 years of follow-up. Four hundred eighty four endomyocardial biopsies were done: 11 (2.3%) had 2R rejection. All survivors are in NYHA (New York Heart Association) functional class I and all but one have normal biventricular function. Conclusion: Mid-term results are similar to those reported by the registry of the International Society for Heart and Lung Transplantation. This experience has a higher proportion of VAD support than previous national series. Rejection rates are low in spite of generic immunosuppression.info:eu-repo/semantics/openAccessSociedad Médica de SantiagoRevista médica de Chile v.141 n.12 20132013-12-01text/htmlhttp://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872013001200001es10.4067/S0034-98872013001200001
institution	Scielo Chile
collection	Scielo Chile
language	Spanish / Castilian
topic	Cardiomyopathies Heart-assist devices Heart transplantation
spellingShingle	Cardiomyopathies Heart-assist devices Heart transplantation Villavicencio,Mauricio Rossel,Víctor Larrea,Ricardo Peralta,Juan Pablo Larraín,Ernesto Sung Lim,Jong Rojo,Pamela Gajardo,Francesca Donoso,Erika Hurtado,Margarita Experiencia clínica con 53 trasplantes cardiacos consecutivos
description	Introduction: Heart transplantation is the therapy of choice for advance heart failure. Our group developed two transplant programs at Instituto Nacional del Tórax and Clínica Dávila. We report our clinical experience based on distinctive clinical policies. Patients and Methods: Fifty-three consecutive patients were transplanted between November 2008 and April 2013, representing 51% of all Chilean cases. Distinctive clinical policies include intensive donor management, generic immunosuppression and VAD (ventricular assist devices) insertion. Results: Ischemic or dilated cardiomyopathy were the main indications (23 (43%) each), age 48 ± 13 years and 48 (91%) were male. Transplant listing Status: IA 14 (26%) (VAD or 2 inotropes), IB 14 (26%) (1 inotrope) and II25 (47%) (no inotrope). Mean waiting time 70 ± 83 days. Twelve (24%) were transplanted during VAD support (median support: 36 days). Operative technique: orthotopic bicaval transplant with ischemia time: 175 ± 54 min. Operative mortality: 3 (6%), all due to right ventricular failure. Re-exploration for bleeding 2 (4%), stroke 3 (6%), mediastinitis 0 (0%), pneumonia 4 (8%), and transient dialysis 6 (11%). Mean follow-up was 21 ± 14 months. Three-year survival was 86 ± 6%. One patient died of Pneumocystis jirovecii pneumonia and the other died suddenly (non-compliance). Freedom from rejection requiring specific therapy was 80 ± 7% at 3 years of follow-up. Four hundred eighty four endomyocardial biopsies were done: 11 (2.3%) had 2R rejection. All survivors are in NYHA (New York Heart Association) functional class I and all but one have normal biventricular function. Conclusion: Mid-term results are similar to those reported by the registry of the International Society for Heart and Lung Transplantation. This experience has a higher proportion of VAD support than previous national series. Rejection rates are low in spite of generic immunosuppression.
author	Villavicencio,Mauricio Rossel,Víctor Larrea,Ricardo Peralta,Juan Pablo Larraín,Ernesto Sung Lim,Jong Rojo,Pamela Gajardo,Francesca Donoso,Erika Hurtado,Margarita
author_facet	Villavicencio,Mauricio Rossel,Víctor Larrea,Ricardo Peralta,Juan Pablo Larraín,Ernesto Sung Lim,Jong Rojo,Pamela Gajardo,Francesca Donoso,Erika Hurtado,Margarita
author_sort	Villavicencio,Mauricio
title	Experiencia clínica con 53 trasplantes cardiacos consecutivos
title_short	Experiencia clínica con 53 trasplantes cardiacos consecutivos
title_full	Experiencia clínica con 53 trasplantes cardiacos consecutivos
title_fullStr	Experiencia clínica con 53 trasplantes cardiacos consecutivos
title_full_unstemmed	Experiencia clínica con 53 trasplantes cardiacos consecutivos
title_sort	experiencia clínica con 53 trasplantes cardiacos consecutivos
publisher	Sociedad Médica de Santiago
publishDate	2013
url	http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872013001200001
work_keys_str_mv	AT villavicenciomauricio experienciaclinicacon53trasplantescardiacosconsecutivos AT rosselvictor experienciaclinicacon53trasplantescardiacosconsecutivos AT larrearicardo experienciaclinicacon53trasplantescardiacosconsecutivos AT peraltajuanpablo experienciaclinicacon53trasplantescardiacosconsecutivos AT larrainernesto experienciaclinicacon53trasplantescardiacosconsecutivos AT sunglimjong experienciaclinicacon53trasplantescardiacosconsecutivos AT rojopamela experienciaclinicacon53trasplantescardiacosconsecutivos AT gajardofrancesca experienciaclinicacon53trasplantescardiacosconsecutivos AT donosoerika experienciaclinicacon53trasplantescardiacosconsecutivos AT hurtadomargarita experienciaclinicacon53trasplantescardiacosconsecutivos
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Experiencia clínica con 53 trasplantes cardiacos consecutivos

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