Long-term prognosis after orthotopic heart transplantation

Introduction. The problem of treating chronic heart failure (CHF) remains one of the most important challenges in cardiology. Despite advances in pharmacotherapy of cardiovascular diseases and the use of the entire arsenal of existing treatment methods, heart transplantation remains the only radical treatment for patients with end-stage heart failure that can significantly improve their prognosis and quality of life.

Objective. To investigate the morbidity, the structural-functional state of the myocardium, and mortality of recipients after orthotopic heart transplantation (OHT) in the long term.

Material and methods. The study included 50 recipients (44 males and 6 females) who underwent OHT at the N.V. Sklifosovsky Research Institute for Emergency Medicine. The mean age of the patients was 51.2±10.5 years. The mean follow-up period after OHT was 6.5±1.5 years.

Results. In the long term after OHT, 16% of recipients were considered healthy; the others were diagnosed with chronic heart failure (CHF) with preserved left ventricular (LV) ejection fraction of functional classes I and II (86%); arterial hypertension (50%); and ischemic heart disease (IHD) without hemodynamic stenosis of the coronary arteries (98%). Normal values of LV global longitudinal and circumferential myocardial strain suggested that after 6 years, the adaptive functions of the heart in transplant recipients was restored, indicating a favorable outcome, confirmed by the absence of remodeling of the right heart chambers and restoration of work capacity (77%). In the long term, side effects of immunosuppressive therapy (oncopathology, post-transplant hypertension, nephropathy, and infections) were observed, which did not differ in frequency from the results of other studies. The mortality rate was 42%. After 1 year, 11.3% had died, and thereafter the mortality rate was 4–6% per year. The highest mortality rate was observed in the first 3 years post-OHT. The main causes of death in the long term were oncological diseases, chronic graft rejection and sudden cardiac death.

Conclusion. In the long term after OHT, 16% of recipients were considered healthy; 77% were capable of work. After 6 years of follow-up, the adaptive functions of the heart in recipients were restored. The long-term mortality rate was 4–6% per year.

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