Info

extremely high: 55% at 8 months. Isolated case reports describing successful coronary artery bypass surgery as treatment for CAV have been published, but such successes are rare. Because of its diffuse nature, transmyocardial laser revascularization (TMR) may be an alternative to either bypass surgery or angioplasty. In a limited number of patients, the results of TMR have been encouraging.

The ultimate treatment for CAV is retransplantation. The indications for retransplantation include 1) the development of severe CAV, 2) the treatment of severe acute early injection, and 3) treatment of early acute right heart failure. The morbidity and mortality rates figures of retransplantation operations are greater than are typically seen with primary transplantation. A retransplant patient should meet the same indications as patients who undergo an initial transplant. Several reports have demonstrated that long-term survival after retransplantation is less than for primary transplantation. There is, however, a significant range in the survival results reported. Data from some institutions indicate that survival rates after retransplantation are comparable to those seen after primary transplantation. As a result, it is often difficult to determine an appropriate algorithm for retransplantation. This is a particularly controversial issue due to the scarcity of available organs. Fortunately, the results for patients undergoing retransplantation for CAV are better than those for patients retransplanted for early rejection or early right heart failure. Unfortunately, by definition the patients with CAV are older and have been chronically immunosuppressed and therefore may be less tolerant of a reoperation.

Selected Readings

1. Carrier M, Ferraro P. Immunosuppression in heart transplantation: History and current and future regimens. In: Emery RW, Miller LW, eds. Handbook of cardiac transplantation. Philadelphia: Hanley & Belfus, Inc. 2000:89-100.

2. Emery RW, Arom KV. Techniques in cardiac transplantation. In: Emery RW, Miller LW, eds. Handbook of cardiac transplantation. Philadelphia: Hanley & Belfus, Inc. 1996:61-86.

3. Hunt SA. Current status of cardiac transplantation. JAMA 1998; 280:1692-1698.

4. Perlroth MG, Reitz BA. Heart and heart-lung transplantation. In: Braunwald E, ed. Heart disease. Philadelphia: W. B. Saunders Co., 1997:520-529.

5. Stevenson LW. Medical management before cardiac transplantation. In: Emery RW, Miller LW, eds. Handbook of cardiac transplantation. Philadelphia: Hanley & Belfus, Inc., 1996:1-10.

Your Heart and Nutrition

Your Heart and Nutrition

Prevention is better than a cure. Learn how to cherish your heart by taking the necessary means to keep it pumping healthily and steadily through your life.

Get My Free Ebook


Post a comment