We retrospectively analyzed 275 consecutive transplanted patients, dividing them into group A (128 patients) affected by ischemiccardiomyopathy and group B (147 patients) affected by dilatedcardiomyopathy. The difference in demographic, clinical and hemodynamicpreoperative and postoperative data between the groups was studied; group Apatients presented at transplantation with a less compromised hemodynamicpicture, requiring inotrope infusion and mechanical assistance lessfrequently. The influence of etiology on early postoperative complicationswas also analyzed: group A patients needed postoperative mechanicalassistance, inotrope, infusion and prolonged mechanical ventilation moreoften, therefore requiring a longer stay in the intensive care unit (ICU).Hospital mortality was twice as high in group A. The older age of group Apatients per se did not influence these results significantly. Thelong-term follow-up was then studied with particular attention toparenchymal functions, hemodynamics, coronary artery disease, metabolic andsurgical complications, and survival. The complication rate was higher ingroup A, with more severe hypertension and higher cholesterol levels at 1year, a higher prevalence of accelerated coronary artery disease (CAD) anda more frequent onset of insulin-dependent diabetes. Surgical and vascularcomplications were also more frequent. The final result was a better 5-year actuarial survival rate for group B patients. Donor and recipient agesat the time of transplant did not influence this result. We conclude thatischemic patients, even if they are transplanted in better condition andoperated more electively, have a more critical early and long-termpostoperative course and a worse survival rate. These findings are notexplained by advanced age, but could be due to the impact ofatherosclerosis and metabolic impairments associated with ischemicdisease.
- Cardiac transplantation
- Coronary artery disease
- Ischemic cardiopathy
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
- Pulmonary and Respiratory Medicine