Abstract
Donor organ shortage and successful experience with left ventricular assist devices as a bridge to transplantation have prompted us to consider a permanent alternative to transplantation. However, we have little information on the long-term follow-up, because the left ventricular assist device has been used as a bridge to transplantation for a period of just over one year. In recipients of a left ventricular assist device, the potential heart-related complications expected include arrhythmia, thromboembolism, valvular heart disease, and progression of ischemic heart disease. Heterotopic heart transplantation (in which the native heart is retained) may be a good model to study long-term pathophysiological processes in the native heart. We analyzed the prevalence of native-heart-related complications in heterotopic heart transplantation to help in predicting the performance of the native heart in patients with a permanent left ventricular assist device. Between December 1984 and December 1994, 16 patients (13 men, 3 women, 37–60 years old) underwent heterotopic heart transplantation at the University of Pittsburgh. The indication for heterotopic heart transplantation in all recipients was pulmonary hypertension unresponsive to vasodilators. The one- and five-year survival rates after transplantation were 81% and 44%. Pulmonary hemodynamics improved significantly after the operation. The actuarial percentages of patients free of complications related to the native heart after one and four years were, respectively: ventricular arrhythmia: 85%, 75%; ischemic heart disease: 85%, 64%; and valvular heart disease: 100%, 88%. The actuarial freedom from all these complications was 70% after one year and 50% after four years. These results will give us an indication of the native heart performance to expect in the patient with a permanent left ventricular assist device.