Heart transplant surgery safe and effective: A Canadian retrospective spanning 3 decades

Heart transplantation is a very safe and effective therapy, according to a new long-term study presented today at the Canadian Cardiovascular Congress 2011, co-hosted by the Heart and Stroke Foundation and the Canadian Cardiovascular Society.

Researchers at the University of Ottawa Heart Institute heart transplant program revealed results from 25 years of follow-up on a total of 461 transplant patients. Mean age at transplant was 49 ±13 years. Patients were followed and managed according to guidelines in effect at the time.

They found that survival rates have improved by more than 20 per cent over the years since modern heart transplantation became available in 1980.

"Heart transplants are amazingly effective therapy," says Dr. Marc Ruel, surgical director of the heart transplant program at the University of Ottawa Heart Institute. "We must remember that half of these patients would otherwise not have lived one year without a transplant."

The Heart Institute found that survival rates have been good over the years, especially from 2003 onward, with more advanced surgical and medical care, where the survival rate at eight years post-surgery is now 89.3 per cent. "Results have significantly improved over the years," says Dr. Ruel.

The study found that overall survival rates for the 25-year period were:

* At one year – 86%
* At five years – 75%
* At 10 years – 62%
* At 15 years – 47%
* At 20 years – 36%

Fifty-five per cent of all patients were status 3 or higher – meaning they had more complicated and urgent medical needs – at transplant.

Cardiac transplantation, also called heart transplantation, has evolved into the treatment of choice for many people with severe heart failure (HF) who have symptoms despite maximum medical therapy. Survival among cardiac transplant recipients has improved as a result of improvements in treatments that suppress the immune system and prevent infection.

Unfortunately, the number of heart donors has reached a plateau despite an increasing number of potential recipients. More than 5000 cardiac transplants occur each year around the world, although it is estimated that up to 50,000 people are candidates for transplantation. This critical organ shortage means that healthcare providers must strictly evaluate who should receive a heart transplant.

Survival was negatively influenced by age at transplant. The younger the patient is at the time of transplant, the more successful the outcome. Each additional 10 years of age decreases the survival rate by 20 per cent, the study found.

Survival was not significantly affected by gender or by whether a patient was on a ventricular assist device − a mechanical pump that helps a weakened heart pump blood throughout the body − pre-transplant.