Heterotopic Cardiac Transplantation: Long-term Results and Fate of the Native Heart.

Abstract Background The long-term results of heterotopic cardiac transplantation have not been well defined. Patient survival rates and fate of the native heart remain unclear. Methods We conducted a retrospective review of all 46 heterotopic cardiac transplants performed at our single institution between 1982 and 2017. Four patients who underwent heterotopic transplant as an emergency procedure for cardiogenic shock were excluded. Three of the procedures were re-transplants in patients who had previously undergone heterotopic transplant; the 3 re-transplants were excluded but the original procedures were not. Follow-up was 100% complete for mortality and 77% complete (30 of 39 patients) for assessment of preoperative indication for surgery and postoperative cardiac function. Results For the 39 patients, the 1-year, 5-year, and 10-year survival rates were 69%, 36%, and 21%, respectively. One patient remains alive 25 years after the transplant. The most frequent indication for heterotopic transplant was having a pulmonary vascular resistance >4 Wood units (n=11), followed by having a weight >112.5 kg (n=7). In most patients, native heart left ventricular ejection fraction stabilized over time to between 10% and 30%. Sinus rhythm was preserved in 87% (26/30) of native hearts at long-term follow-up. Conclusions Heterotopic cardiac transplantation is an acceptable procedure that should be considered for obese patients (especially those heavier than 112.5 kg) and patients with elevated pulmonary vascular resistance (especially those with pulmonary vascular resistance >4.0 Wood units). After heterotopic transplant, native cardiac function appears to stabilize, and there is significant potential for native heart recovery.