ORIGINAL ARTICLE
Long-term outcome after heart transplantation performed in the University Medical Centre Groningen J. Brugemann, I.C.C. van der Horst, D.J. van Veldhuisen, S.A.J. van den Broek, A.T.G. de Jonge-Weber, T. Ebels, P.W. Boonstra, F. Zijlstra
Background. Ten years ago, there was a difference of opinion about the suitability of ventilated patients with end-stage cardiac failure for heart transplantation (HTX). Although guidelines at that time qualified mechanical ventilation as a contraindication, we thought those patients could be candidates for HTX. In the same period a number of other patients received a donor heart in our centre. In this artide we describe the dinical course and survival after these procedures. Methods. We performed a retrospective study using our post HIX database. All patients undergoing transplants in our hospital were selected. Patients underwent echocardiography, scintigraphy (MUGA), ergo-spirometry (VO2 peak), blood tests and completed a quality of life questionnaire (SF-36). All tests were completed in the 1st quarter of 2006. Results. Eight patients were identified; three were mechanicaily ventilated at the time of HTX. AU eight patients were treated according to the standard protocol. Repeated surveillance cardiac biopsies were taken. One patient died 3.5 years after HTX due to an acute myocardial infarction. Seven patients, including the three patients on a ventilator at the time of the HTX, are alive, J. Brdgemann I.C.C. van der Horst DJ. van Vedhulsen SAJ. van den Brook A.T.G. de Jonge-Weber T. Ebels P.W. Boonstra F. Zijstra Department of Cardiology and Cardiothoracic Surgery, Thorax Centre, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
Correspondence to: J. Brugemann Thoraxcentre, Department of Cardiology, University Medical Centre Groningen, PO Box 30001, 9700 RB Groningen, the Netherlands E-mail:
[email protected]
Netherands Heart Journal, Volume 14, Number 12, December 2006
resulting in a survival rate of 88%. The current median survival time is 126 months (range 55 to 184 months). AU patients are in good cardiac condition. The SF-36 domains of social functioning and mental health show high scores, the average score of general health and vitality is moderate. Conclusion. Survival of our eight transplanted patients after a median period often years was 88%, which is at least comparable with data from larger series. This finding suggests that HTX can be performed effectively and safely in a low volume centre. The finding that all three patients on a ventilator prior to HIX are alive is remarkable. It appears that mechanical ventilation is not always an absolute contraindication for HTX. (Neth Heart J2006;14:405-8.)
Keywords: heart transplantation, follow-up (longterm), quality of life eart transplantation (HTX) is the treatment of
choice for end-stage heart failure for selected patients. The indications and contraindications for HTX in the Netherlands have been published.' The very first procedure was carried out in 1967. In the Netherlands the HTX programme started in 1984 (Erasmus Medical Centre, Rotterdam). At the Heart Lung Centre ofthe University Medical Centre Utrecht (UMCU) the first procedure was performed in 1985. These two centres are currently licensed to perform HTX. Since 1985, our cardiology departnent has been treating patients before and after heart transplantation. The actual operation of patients from the northern provinces is usually performed in the UMCU. There is a formal collaboration with the Heart Lung Centre ofthe UMCU with respect to selection ofcandidates for the procedure and placement on the waiting list. In the past 20 years approximately 70 patients, referred by our hospital, have been successfully transplanted. The cooperation with the Heart Lung Centre in the UMCU has always been fruitful, although in the mid-
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Long-term outcome after heart transplantation performed in the University Medical Centre Groningen
1990s there was a difference in opinion with regard to mechanical ventilation as a potential contraindication for HTX.2,3 Some ofthe patients were transplanted in our centre while on mechanical ventilation. In other cases the patient was haemodynamically too unstable to allow transportation to Utrecht and it was decided that surgery in our hospital was the only option. In this report we describe the current physical, social, and mental status of these patients. Patients and Methods Patients who underwent an HTX in the University Medical Centre Groningen (UMCG) were identified in our post HTX database. Using the database, we counted the number and classified the severity of right ventricular biopsy rejection episodes in the patients who received a donor heart in our hospital. The classification of the International Society for Heart and Lung Transplantation (ISHLT) was used. Histological gradation types 0, IA, 1B, 2, 3A, 3B and 4 are iden-
tified in the classification.4 Pathological anatomical examination data were retrieved for the patient who died. The other patients were asked during a regular outpatient clinic visit to participate in this study. They underwent echocardiography, left ventricular ejection fraction assessment using scintigrapy (MUGA), exercise test (ergo-spirometry = VO2 peak), blood tests and were asked to complete a SF-36 questionnaire in order to measure quality oflife. Echocardiography was performed using a Vmgmed System Five device and the left parasternal long-axis view was used to measure left ventricular end-diastolic and systolic diameters in a manner that is internationally accepted. Global left ventricular function (eye-ball impression) was assessed by experienced echocardiography supervisors not involved in this study. Qualification is done in four categories: normal, reasonable, moderate and poor. At our departnent of nuclear medicine, scintigraphy was preformed by means of the MUGA technique using 500 MBq Tc-labelled erythocytes. Ejection
Table 1 Baseline characteristics and 1st quarter 2006 follow-up data of eight heart transplant patients. Patient Gender Pre-HTX Pre- Date Birth dIagHTX HTX no. nosis ventIyear lator 1
Male 1963
DCM
2
Male 1944
ICM
Male 1960
ICM
4t
Male 1959
5 6
Rejections Medical during 1st remarks
Social remarks
year post-
HTX
Echo LVEF- Blood Current V02 NYHA LVEDD/ MUGA creatinine peak class ESD (ml (%) (mm) min/kg)
January 1991
All
