Heart Transplantation in Patients with End-Stage Heart failure and Cardiac Ascites
|Authors:||許榮彬||Keywords:||heart transplantation;ascites||Issue Date:||31-Jul-2005||Publisher:||臺北市：國立臺灣大學醫學院外科||Abstract:||
Objective: Donor shortage and improved medical treatment of heart failure increase the
prevalence of patients with end-stage heart failure and cardiac ascites to heart transplantation.
The clinical outcome of heart transplantation in these patients has not been reported. Here, we
sought to evaluate the clinical outcome of heart transplantation in patients with end-stage
heart failure and ascites.
Methods: Data were collected by retrospective chart review.
Results: Between 1989 and 2005, 45 patients with end-stage heart failure and moderate to
severe ascites underwent orthotopic heart transplantation. There were 33 men and 12 women
with median age of 44 years (range 10-63 years). The causes of heart failure were congenital
heart disease in 4 patients (9%), dilated cardiomyopathy in 21 patients (47%), rheumatic
heart disease in 7 patients (16%), coronary artery disease in 10 patients (22%), and restrictive
cardiomyopathy and transplant coronary artery disease each in 1 patient. Twenty of 45
patients (44%) had previous cardiac operation. There were 10 in-hospital deaths (22%):
bleeding in 4 patients, sepsis with multiple organ failure in 5 patients and non-diagnostic
graft failure in 1 patient. Profuse postoperative bleeding requiring reoperation occurred in 14
patients (31%). The independent risk factors for hospital death were low serum albumin
(odds ratio, 0.05; 95% confidence interval, 0.003-0.591; p=0.018) and reoperation for
bleeding (odds ratio, 30.11; 95% confidence interval, 2.38-380.26; p=0.009).
Conclusions: Heart transplantation in patients with end-stage heart failure and ascites was
associated with high hospital mortality and morbidity. The co-existence of cardiac ascites and
hypoalbuminemia implied poor prognosis.
|Appears in Collections:||醫學系|
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