Cardiac Transplantation for Dilated Cardiomyopathy

In recent years, new approaches for the medical treatment for heart failure have evolved. While the use of vasodilators and specifically angiotensin converting enzyme inhibitors has improved both functional status and survival, long term prognosis unfortunately remains poor [1–4]. Since the initial human heart transplant over 20 years ago, there has been a progressive improvement in long-term survival [5]. Moreover, cardiac transplantation results in marked alleviation of symptoms and improved quality of life in patients with end stage heart failure. Indeed, patients undergoing successful cardiac transplant are capable of resuming normal physical activity which is in sharp contrast with their severe physical limitations prior to surgery. With the availability of cyclosporine [6], the cardiac transplantation program at University Hospital, London, Canada commenced in April 1981. Between then and December 1988, 186 transplants were performed in 179 patients with end-stage heart disease. Heart failure was the result of ischemic heart disease (IHD) in 86 patients and cardiomyopathy (CM) in 80 patients. In the remainder, transplantation was for end-stage valvular heart disease in eight, congenital heart disease in five, and seven patients required retransplantation. In this discussion only the patients with IHD and CM will be evaluated. Of the 80 patients with CM, one patient had amyloidosis, two hypertrophic CM, one postpartum CM, one adriamycin-induced CM, and one patient had acute myocarditis. In the remainder no identifiable cause of dilated CM was identified.