Intensified medical therapy in heart transplant candidates

Autor: Volker Döring, Wilfried Rödiger, Hans-Martin Stubbe, Herbert Nägele, Peter Kalmár
Rok vydání: 1997
Předmět:
Zdroj: The Asia Pacific Heart Journal. 6:178-183
ISSN: 1328-0163
DOI: 10.1016/s1328-0163(97)90027-0
Popis: Background : Because of donor shortage, heart transplantation (HTx) as therapy for end-stage heart failure is limited by a mortality rate of 25% on waiting lists, and lists are steadily increasing. Aim : To analyse whether an intensive medical therapeutic regimen for heart failure (based on the results of frequent haemodynamic studies) can delay or even prevent the need for HTx. Methods : Data analysis of 517 patients who were referred to our institution for HTx from 1984 to 1996 is presented. Characteristics and management of 359 non-emergency, New York Heart Association (NYHA) III or IV heart transplant candidates, without contraindications (and with sufficient compliance) are described. All candidates receiving conventional therapy with ACE inhibitors, digitalis and diuretics at entry were evaluated. Drug therapy was intensified as follows: a further reduction of preload; a further reduction of afterload; individualised diuresis; and amiodarone therapy. Results : Under this regimen, clinical and haemodynamic parameters improved in many patients. Only 95 patients (26%) were primary non-responders to intensified medical therapy and had to be listed for HTx early (during the first year of follow-up). Actuarial survival rates of the early listed versus the early responding HTx candidates, at 1 and 5 years, were 68.3%/87% and 41%/59%, respectively (p=0.02). An additional benefit of co-therapy with amiodarone and calcium antagonists was found. The most important mode of cardiac death was sudden (32% at 5 years), whereas mortality due to pump failure was much lower (13% at 5 years). Only 38 patients (16%):had to be listed for HTx in further follow-up. Conclusions : Intensive medical therapy in heart transplant candidates may be an alternative to immediate HTx, especially in times of donor shortage or in countries without a transplantation program. Responders to therapy showed a similar or even better prognosis than HTx patients. This conservative approach may allow available donor hearts to be saved for those patients most needing a transplant.
Databáze: OpenAIRE
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