[Global experience and results of heart transplantation].

OBJECTIVES: This article summarizes the general experience and results achieved by heart transplantation during 19 years of activity.

MATERIALS AND METHODS: Between 1987 and 2005, 439 heart transplantations and 24 cardiopulmonary transplantations were performed by the Cardiovascular Surgery Department of Hospital Universitario La Fe, Valencia, Spain. Indication variation over time, donor/receptor profiles, urgent vs. programmed transplantations and short/long term results over different periods of time were subject to analysis, while correlating the results with changes of surgical technique, myocardial protection and immunosuppression protocols.

RESULTS: For the last 5 years, the number of heart transplantations remained stable at 30 cases per year. The most frequent etiology was ischaemic cardiopathy (41%); 25% of the emergency heart transplantations were carried out in patients with inotropic support, mechanical ventilation and/or intraaortic balloon pump contrapulsation. The early mortality rate was 8%, and 4,7% considering only the last period; the most frequent cause of death during the first postoperative month was acute graft failure, followed by infection. After the first year, graft vascular disease was the leading cause of mortality. Emergency transplantation and re-transplantation had a significantly higher mortality.

CONCLUSIONS: Cardiac transplantation is the best treatment for terminal miocardiopathies. The early mortality rate was low. At present time, the number of heart transplantations became stable due to a low number of donors. In the future, better prevention and treatment of graft vascular disease shall be achieved in order to increase long-term survival. The comparative analysis of survival shows similar results to others published in the world scientific literature, including a continuing trend towards improving survival over the last years.