Transplante cardíaco. Experiencia de 22 años

During the last decades, cardiac transplantation developed as a therapeutic modality and allowed to many patients suffering a terminal cardiac insufficiency, survive to de disease with an optimal quality of life. At the beginning the problems were not few, and for this reason, this surgery stopped momentarily its development, but later on, it could reappear more strongly. A total of 100 cardiac transplants, including one cardiopulmonar, one heterotopic and one cardiorenal, were performed in this time. The indications have changed and contraindications decreased because of the better management of the concomitant disorders which originated them, with a more effective management of the pulmonary hypertension. Also the age and his rate has changed, since 12 to 55 years at the beginning. At present, patients between 0 and 70 years are usually transplanted. But, due to the low number of donors, more limited or suboptimal donors have been choosed, in addition to performing operatives at a distance. With the introduction of Ciclosporin A and the immunosupressive induction therapy, the rate of rejects decreased significatively. Besides, several dispositives of ventricular assistance were developed helping the transplants in several opportunities. At present, the average survival rate in cardiac transplantation was 76% at 1 year and 65% at 5 years. The most adequate cardiological management of cardiac insufficiency and the availability of patients still not in multiorganic failure, will help the survival rate of the transplanted patients from our country.