Jun 11, 2007 - waiting list for heart transplantation for the last one year were ... and long-term survival of patients undergoing HTx after multiple redo ... No acute rejection episode ... We have developed, using dual-channel photoplethys-.
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Monday, 11 June 2007
567 Should UNOS status 2 patients undergo transplantation? H. Duygu 1 , M. Zoghi 2 , S. Nalbantgil 2 , S. Akyuz 2 , M. Akin 2 , T. Yagdi 2 , M. Ozbaran 2 1 Ege University Medical Faculty, Cardiology, Kardiyoloji Anabilimdali, Izmir, Turkey; 2 Ege University Medical Faculty, Cardiology, Izmir, Turkey Purpose: Despite recent developments in medical and assist device treatments, management strategies in the end stage heart failure patients with UNOS 2 status is being discussed. Particularly, superiority of the heart transplantation over conservative treatment in this patient group has not been proven yet. In the present study, the clinical situation and prognosis of end stage heart failure patients with UNOS 2 status, who were on the waiting list for heart transplantation for the last one year were evaluated. Methods: A total of 78 patients (mean age: 43±12 years, 80% males) of UNOS 2 status, who were short-listed for the heart transplantation program between February 1998 and June 2005 were included in the study. We performed a retrospective review to determine outcomes in these patients. Results: The etiology of heart failure was ischemic cardiomyopathy in 21 (27%) patients, dilated cardiomyopathy in 53 (68%), other causes (restrictive cardiomyopathy, hyperthrophic cardiomyopathy, arrhythmogenic right ventricular dysplasia) in 4 (5%). Left ventricular ejection fraction was 26±8%, where as right ventricular ejection fraction was 45±12%. The mean period of waiting list was 17±10 months and hospitalization frequency was 4±2/year for all patients. During the follow up period, 9 (8%) of UNOS 2 patients shifted to UNOS IB status and 18 (23%) patients underwent orthotopic heart transplantation. The annual mortality rate among the patients on the waiting list was 25% (15 patients, 75% had sudden cardiac death), where as it was 20% (4 patients) among transplanted patients at the end of the first year after the transplantation (p=0.03). The rate of mortality and shift to UNOSIA of patients in waiting list was also higher in favor of transplanted patients (p=0.01). Conclusions: During the waiting process, mortality rate and frequency of heart failure attack in candidates of heart transplantation with UNOS 2 status are high, despite optimal medical treatment. The mortality rate is lower among transplanted patients compared to those under medical treatment during follow up period. When the shift to the upper classes is considered, the difference becomes more marked. Therefore, to prevent future clinical deterioration, frequent heart failure attacks and sudden cardiac death in patients with this status, heart transplantation may be a alternative treatment. 568 Redo cardiac surgery: is there an impact on heart transplantation outcome? A single centre experience G. Guzzi, E. Spagna, V. Tursi, M.C. Albanese, D. Miani, E. Mazzaro, E. Auci, U. Livi University-General Hospital, Dept of CardioPulmonary Sciences, Udine, Italy Purposes: In recent years, an increasing proportion of candidates for heart transplantation (HTx) sustained one or more previous cardiac operations (PCO). Aim of the study was to evaluate the preoperative management and long-term survival of patients undergoing HTx after multiple redo operation compared with those after only one surgical procedure. Methods: Between 1985 and 2005, 83 HTx were performed in patients who had undergone PCO, once (64 pts, group A) or twice or more (19 pts, group B). Patients groups were analyzed regarding their pre-, intraand post-operative variables in addition to survival. Results: Pre-operative events were comparable in both groups, except for total bilirubin (1.05 mg/dL vs. 1.44 mg/dL; p
