Middle- and long-term survival of patients with heart transplant in Mexico from 1988 to 2023: A group experience

Abstract

BACKGROUND

Heart transplantation is the last and best option for end-stage heart failure management. Early mortality rates have significantly decreased, enabling patients to survive longer with fewer complications, a trend observed even in our setting. The primary shared challenge has centered on achieving surgical success and immediate survival. The question arises about the medium- and long-term survival of patients with heart transplant in Mexico.

AIM

To present the results of the medium and long-term follow-up of heart transplant patients.

METHODS

This was a retrospective study of a single medical unit, and we selected patients who received heart transplants from July 21, 1988 to September 30, 2023. Selection criteria encompassed age, sex, and primary indication for heart transplantation across all groups. Patients with incomplete information or who died within 30 postoperative days were excluded. Data of primary pathology, ischemic, extracorporeal circulation, aortic cross-clamping times, length of ventilatory support, stay in postoperative therapy, hospitalization, and functional class were analyzed.

RESULTS

The causes of morbidity, mortality, and percentage of survival at 1, 5, and 10 years were examined. Overall, 257 heart transplants were performed during the study period. Of the total cases, 22 with incomplete data and 47 who died within 30 postoperative days were excluded for the middle- and long-term survival analyses. Of the remaining 188 patients, heart transplantation was performed (males: 146, females: 42). The average age of the participants was 44.43 ± 14.48 years. The primary indications included ischemic cardiomyopathy (42.55%) and dilated cardiomyopathy (39.36%). The mean durations of mechanical ventilator support, intensive care stay, and hospital stay were 57.55 ± 103.50 hours, 9.96 ± 8.59 days, and 19.49 ± 18.23 days, respectively. One-, five-, and ten-year survival rates were 90.7%, 71.3%, and 60.3%, respectively. Of the patients, 94% and 6% were in functional classes I and II, respectively. Infection and neurological hemorrhagic or ischemic stroke (26%) were the main causes of mortality in the first year. Subsequently, chronic rejection manifesting as graft vasculopathy increased in frequency (30%).

CONCLUSION

In our setting, heart transplantation yields medium- and long-term survival and quality of life outcomes comparable to those achieved by other international centers.

Keywords: Heart transplantation; Graft vasculopathy; Rejection reaction; Immunosuppression; Survival

Core Tip: In Mexico, ensuring surgical success and immediate survival in heart transplantation recipients constitute a significant challenge. The dilemma arises regarding the medium- and long-term survival of patients receiving heart transplant. The results of this review revealed 1- and 5-year survival rates of 90% and 71%, respectively. Notably, globally, current selection criteria for heart transplant candidates now include patients who were previously deemed ineligible. Adapting short- and long-term treatment and management protocols will be necessary.