The Annals of Thoracic Surgery, Vol 45, 192-197, Copyright © 1988 by The Society of Thoracic Surgeons
The changing face of cardiac transplantation: the Washington University Program, 1985-1987
RM Bolman 3d, C Cance, T Spray, R Genton, C Weiss, J Saffitz and H Eisen
Department of Surgery, Washington University School of Medicine, St. Louis, MO.
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.(ABSTRACT TRUNCATED AT 250 WORDS)
