The Changing Face of Cardiac Transplantation: The Washington University Program, 1985-1987

R. Morton Bolman, Connie Cance, Thomas Spray, Randall Genton, Carey Weiss, Jeffrey Saffitz, Howard Eisen

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Since January, 1985, 59 patients have undergone 62 heart transplantations at Washington University School of Medicine. The experience in this program serves as a useful microcosm of the field of cardiac transplantation as a whole to demonstrate certain trends that are becoming evident. Of the patients, 47% had coronary artery disease compared with 40% with cardiomyopathy. Fourteen patients (24%) were 55 years old or older at the time of transplantation. Sixteen patients (27%) required mechanical support of respiration or circulation or both prior to transplantation. Six patients were maintained with a left ventricular or biventricular assist device, and all survived; 1 patient received extracorporeal membrane oxygenation and lived; 7 patients were maintained with an intraaortic balloon pump, 6 of whom survived; and 2 were maintained with a mechanical ventilator and survived. The preoperative waiting period averaged 51 days for the group as a whole. Status-3 patients experienced an average 81-day waiting period, and those in blood group O waited 155 days. In contrast, critically ill patients (status 0) underwent transplantation within an average of 9 days. Actuarial survival at 12 months for all patients, operative survivors, patients age 55 years old or more, and patients bridged to transplantation was 87%, 92%, 84%, and 87%, respectively. Utilizing the combination therapy of cyclosporine, azathioprine, and prednisone introduced by one of us in 1983 and administered to all patients in this series, 50% of patients were rejection free and 56% were infection free at 12 months. There has been one case each of fatal infection and rejection. This series demonstrates that the patient with a low-priority status can expect to experience a prolonged preoperative waiting period. In contrast, the patient requiring heroic support preoperatively can expect to undergo transplantation more expeditiously. These data suggest that transplantation can be safely offered both to the desperately ill patient requiring mechanical support and to the patient in the latter half of the sixth decade of life.

Original languageEnglish (US)
Pages (from-to)192-197
Number of pages6
JournalAnnals of Thoracic Surgery
Volume45
Issue number2
DOIs
StatePublished - Jan 1 1988

Fingerprint

Heart Transplantation
Transplantation
Preoperative Period
Extracorporeal Membrane Oxygenation
Azathioprine
Mechanical Ventilators
Blood Group Antigens
Prednisone
Infection
Cardiomyopathies
Critical Illness

All Science Journal Classification (ASJC) codes

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Bolman, R. Morton ; Cance, Connie ; Spray, Thomas ; Genton, Randall ; Weiss, Carey ; Saffitz, Jeffrey ; Eisen, Howard. / The Changing Face of Cardiac Transplantation : The Washington University Program, 1985-1987. In: Annals of Thoracic Surgery. 1988 ; Vol. 45, No. 2. pp. 192-197.
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abstract = "Since January, 1985, 59 patients have undergone 62 heart transplantations at Washington University School of Medicine. The experience in this program serves as a useful microcosm of the field of cardiac transplantation as a whole to demonstrate certain trends that are becoming evident. Of the patients, 47{\%} had coronary artery disease compared with 40{\%} with cardiomyopathy. Fourteen patients (24{\%}) were 55 years old or older at the time of transplantation. Sixteen patients (27{\%}) required mechanical support of respiration or circulation or both prior to transplantation. Six patients were maintained with a left ventricular or biventricular assist device, and all survived; 1 patient received extracorporeal membrane oxygenation and lived; 7 patients were maintained with an intraaortic balloon pump, 6 of whom survived; and 2 were maintained with a mechanical ventilator and survived. The preoperative waiting period averaged 51 days for the group as a whole. Status-3 patients experienced an average 81-day waiting period, and those in blood group O waited 155 days. In contrast, critically ill patients (status 0) underwent transplantation within an average of 9 days. Actuarial survival at 12 months for all patients, operative survivors, patients age 55 years old or more, and patients bridged to transplantation was 87{\%}, 92{\%}, 84{\%}, and 87{\%}, respectively. Utilizing the combination therapy of cyclosporine, azathioprine, and prednisone introduced by one of us in 1983 and administered to all patients in this series, 50{\%} of patients were rejection free and 56{\%} were infection free at 12 months. There has been one case each of fatal infection and rejection. This series demonstrates that the patient with a low-priority status can expect to experience a prolonged preoperative waiting period. In contrast, the patient requiring heroic support preoperatively can expect to undergo transplantation more expeditiously. These data suggest that transplantation can be safely offered both to the desperately ill patient requiring mechanical support and to the patient in the latter half of the sixth decade of life.",
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The Changing Face of Cardiac Transplantation : The Washington University Program, 1985-1987. / Bolman, R. Morton; Cance, Connie; Spray, Thomas; Genton, Randall; Weiss, Carey; Saffitz, Jeffrey; Eisen, Howard.

In: Annals of Thoracic Surgery, Vol. 45, No. 2, 01.01.1988, p. 192-197.

Research output: Contribution to journalArticle

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