Heart Transplantation in Patients With End-Stage Heart Failure and Cardiac Ascites

Abstract

Background Clinical outcome of heart transplantation in patients with heart failure and ascites has not been reported. Here, the clinical outcome of heart transplantation in patients with heart failure and ascites is evaluated. Between 1989 and 2005, 45 patients with heart failure and ascites underwent an orthotopic heart transplantation. Of the 45 patients, 33 were men (median age 44 years, range 10-63 years). Causes of heart failure included 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 others. Twenty of the 45 patients (44%) had undergone a previous cardiac operation. Hospital mortality occurred in 10 patients (22%) because of bleeding in 4, sepsis with multiple organ failure in 5 and non-diagnostic graft failure in 1 patient. Re-operation for postoperative bleeding occurred in 14 patients (31%). 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 re-operation for bleeding (odds ratio 30.11; 95% confidence interval 2.38-380.26; p=0.009). Conclusions Heart transplantation in patients with heart failure and ascites was associated with high hospital mortality and morbidity. The co-existence of ascites and hypoalbuminemia implied poor prognosis. (Circ J 2007; 71: 1744 -1748 Methods and Results

Would access to device therapies improve transplant outcomes for adults with congenital heart disease? Analysis of the United Network for Organ Sharing (UNOS)

“…Most of these patients have had prior sternotomies that could complicate VAD insertion and their recovery. Comorbidities of CHD such as protein-losing enteropathy and occult liver disease [25][26][27] may increase the risk of infection, contribute to hemorrhage or thrombosis, and impair wound healing after VAD implantation. This study sheds light on the uncommon usage of VADs in adults with CHD awaiting OHT.…”

Heart transplantation in patients with liver cirrhosis

“…Liver biopsy remains a pivotal role in evaluation of the grade of inflammation and stage of cirrhosis before transplantation. Liver biopsy may be indicated in patients with cardiac ascites and hypoalbuminemia before transplantation [25]. The presence of extensive liver fibrosis would disqualify patients from transplantation and the only viable option for these patients with cardiac cirrhosis would be combined heart and liver transplantation.…”

The liver in heart failure: a biopsy and explant series of the histopathologic and laboratory findings with a particular focus on pre-cardiac transplant evaluation

“…The risk of perioperative death is markedly increased by cirrhosis due to any cause, [3][4][5] and cirrhosis is also associated with increased post-operative complications following cardiac surgery, [6][7][8][9] including increased rates of sepsis and bleeding. Serum bilirubin has been found to correlate with operative mortality and with the presence of cardiac cirrhosis in patients with primary pulmonary hypertension undergoing heartlung transplantation.…”