Transplante cardíaco ortotópico: experiência na Universidade Federal de S？o Paulo

from november, 1986 to april, 1997; 92 orthotopic heart transplants were performed, with recipient mean age of 44,9 years (range 3 to 63 years). recipient diagnoses included dilated cardiomyopathy in 42 (44.6%) ischemic cardiomyopathy in 23 (25%), chagas disease in 21 (22.8%), valve disease in 3 (3.2%) patients. the surgical technique used (described by lower e shumway, in 1960, with minor modification) was satisfactory and without complication. graft ischemic time - longer in heart transported from other institutions compared to side-by-side transplantation - was always less than 4 hours. the most common chronic complications of immunosuppressive therapy were: arterial hyperthension (84.6%), hyperuricemia (75.4%) and hypercholesterolemia (63%). regarding infections, viral were the most common ones with 92 (45.6%) followed by bacterial with 35 (38.0%), and protozoal with 15 (16.3%) cases. among bacterial infections, 7 occurred in the surgical wound, with good evolution. among those infections caused by protozoal, 7 (46.6%) were due to trypanossoma cruzi. the overall mortality rate within 30 days of transplantation was 17.3%, with infection, neurologic complications and rejection as major causes. from 30 days to 1 year of transplantation, the mortality rate was 10.3%, with infection and rejection as primary causes. and after one year post-transplantation, the mortality rate was 14%, with several different causes: sudden death, infection, rejection and others. the actuarial survival estimates at 1, 2, 3, 4, 5, and 6 years were 71.6%, 66.5%, 60.5%, 54.4%, 54.4% and 54.4%, respectively. there were no follow-up losses, and all the surviving patients are in functional type i of the nyha. cardiac transplantation procedure is possible in our community with accetable survival and post-operative complication rates acceptable, even though different from international statistics.