Attenuation of waiting time mortaility with heterotropic heart transplantation

As the number of heart transplants and the number of transplant programs has increased, so has the waiting time for a suitable organ. To more accurately assess the magnitude of this increase and the influence of recipient size, we reviewed waiting times for large (body surface area ≥ 1.95 m²) and small (body surface area < 1.95 m²) patients with respect to era of transplantation. Patients who underwent transplantation early (1984 to December 31, 1986) waited 35 ± 47 days (mean ± standard deviation), whereas patients who underwent transplantation in the late era (1987 to September 30, 1989) waited 83 ± 102 days (p = 0.001). Large patients waited longer (130 ± 142 days) in the late era than did small patients (60 ± 67 days; p = 0.008). During the heterotopic era (October 1, 1989 to June 30, 1990), waiting times for large patients who received a heterotopic transplant (67 ± 46 days) were significantly shorter than those for patients who received an orthotopic transplant (166 ± 157 days; p = 0.05). Waiting times for small patients remained unchanged. In addition, waiting time mortality decreased from 24% to 9% (p < 0.05). Comparison of orthotopic and heterotopic procedures performed during the same era revealed no significant differences in recipient age, preoperative status, graft ischemic time, donor age, early and midterm survival, or early postoperative functional status. Heterotopic heart transplantation may effectively increase the size of the donor pool, decrease the waiting time, and decrease waiting time mortality without increasing the morbidity of the procedure.