Some Imperfect Hearts OK for Transplant

HealthDay News – A heart needn’t be perfect to be used in a transplant, a new study shows.

Five-year results for people given hearts with mild-to-moderate left ventricular hypertrophy (LVH) – a thickening of the heart’s main pumping chamber – were as good as for those who got hearts with no problems, cardiologists at Cedars-Sinai Medical Center in Los Angeles report in the March 25 issue of the Journal of the American College of Cardiology.

The findings might help expand the donor pool for heart transplants, one expert said.

“Up to this time, any patient who had more than minor LVH would not be accepted into our donor pool because we thought we would have worse results over time. This paper suggests that is not the case,” said Dr. Allan Stewart, director of aortic surgery at NewYork-Presbyterian Hospital/Columbia University Medical Center, in New York City.

In the Cedars-Sinai study, the largest of its kind to date, researchers reviewed outcomes for 427 patients who underwent heart transplant at the center between 1989 and 2004.

The survival rate of the 62 recipients of transplanted hearts with LVH was comparable with that of 365 people who got hearts without LVH, said study senior author Dr. Alfredo Trento, director of cardiothoracic surgery at Cedars-Sinai.

In the first 30 days, 98 percent of those getting heart with LVH survived, compared to 97 percent of those getting normal hearts. The five-year survival numbers were even better for people getting LVH hearts – 84 percent, compared to 70 percent for those getting normal hearts. But those better results were a statistical quirk, he added quickly: “I don’t think you can make any inference from that.”

Cedars-Sinai surgeons began accepting LVH hearts “because the donor pool was not providing enough donors, so you have to go to less optimal – but what we think are still good – hearts,” Trento said.

Reluctance to accept LVH for transplant was due to “worry because these hearts are not as compliant,” he said. “If a heart is thick it cannot relax enough to receive blood, so you have what we call diastolic dysfunction.”

However, based on the results thus far, “we will continue to use them,” Trento said. “Some people say that if you follow up patients with these hearts, they don’t behave as they should. But they do. We have noticed that when we do an echocardiogram on follow-up, the heart sort of tends to regress toward normal.”

The Cedars-Sinai results could well affect medical practice, Trento said. “In this environment where the donor pool is not optimal, I think this paper will move people to take hearts with moderate LVH,” he said.

NewYork-Presbyterian’s Stewart agreed. His hospital has the largest heart transplant program in the country, averaging over 100 operations per year.

While he was encouraged by the Cedar-Sinai study, he added that, “of course before we completely change our practice we would want to see more data.”

Any change in the program would be driven by the same shortage of donor hearts that motivated the Cedars-Sinai cardiologists, Stewart said. “Right now we’re limited by the available list of donors,” he said. For someone who has been on the list for a transplant for long enough to arouse concern, “I would be more apt to take a heart with LVH based on this article,” he said.

“Normally we would say we don’t accept donors with LVH,” Stewart said. “Now we can try it and see what our own experience is.”

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