Patients with serious heart failure: indications to heart transplantation and selection of donors and receptors
Palavras-chave:Heart Failure, Heart transplantation, Donor selection, Patient selection
Introduction: Heart failure (HF) is a complex syndrome where heart failure occurs in providing adequate blood supply to the metabolic needs of tissues through high filling pressures. It causes approximately 20% of all hospital admissions among people over 65. Measure whether the functional class increases mortality in the same proportion.
Objectives: Analyze how the indications for heart transplantation are made, selection of donors and recipients and to evaluate the survival of patients after transplantation.
Methodology: Research conducted in the database Science, Science Direct, Pubmed and Revista Medicina - FMUSP, between the years 2007 to 2018, with analysis of articles of greater relevance.
Results: In the international literature, several studies are found on prognostic factors and risk scores for patients with HF undergoing outpatient follow-up; however, this information is heterogeneous. In the sample of this study (patients referred for heart transplantation), the clinical and laboratory data of these patients, or those who selected the prognostic parameters and, based on these variables, using a prognostic score, were analyzed. The average follow-up period was five years and the patients' survival in the first year was 84.5%, in the second year it was 74.3%, in the third year it was 68.9%, in the fourth year it was 64, 8% and, last year, were 60.5%. The prognostic variables selected in the univariate analysis, which were statistically significant, were: age, clinical etiology, functional classes III and IV, orthopnea, systolic blood pressure, mean arterial pressure, mean arterial pressure, mean arterial pressure, pulse pressure, plasma urea, plasma, blood glucose, albumin, bilirubin, hemoglobin and average heart rate and the variables multivariates analysis were: ejection fraction, urea and hemoglobin.
Discussion: Heart transplantation is an important alternative to improve the survival of patients with HF and a single surgical way to restore hemodynamic functions and improve the quality of life and survival of these patients with severe HF. However, there are restrictions, created by the increased demand for recipients in the face of permanent donor output. In order to obtain the organs in the best conservation conditions, there was a need to apply the concept of brain death. To reduce myocardial injury, donors can be maintained artificially with the use of ventilators and catecholamines, so hemodynamic conditions are available until the time of cardiectomy. The ischemic time in the heart must not exceed the limit of 4 to 6 hours or transplantation is performed safely. The condition of the recipient must be judicious with the identification of risk factors and coexisting illnesses. Patients in cardiogenic shock take priority on the transplant list, due to their high mortality. Median thoracolaparotomy is an access route for exposure of intracavitary organs. The incidence of tricuspid insufficiency in the postoperative period of heart transplantation varies from 40 to 90% of cases. The main indication for heart transplantation in Brazil and in the world, as it has a lower incidence of comorbidities, is dilated cardiomyopathy, although the most frequent etiology in HF is ischemic.
Conclusion: Despite the satisfactory survival, it deals with samples from patients with severe heart failure, suggesting that these patients can be maintained in optimized clinical treatment until they present persistent clinical deterioration. The ejection fraction, ventricular diameters and functional class should not be used in isolation to indicate heart transplantation. The risk score can be useful to discriminate against a population with a worse prognosis.
Keywords: Heart Failure; Heart transplantation; Donor selection; Patient selection
Copyright (c) 2020 Lays Andrade, Maria Eduarda Mattar Ribeiro, Andressa Alves Batista, Samara Ariane Melo, Ana Beatriz Galhardo, Murilo Santana Fonseca , Cláudia Helena Cury Domingos Roselino
Este trabalho está licenciado sob uma licença Creative Commons Attribution-ShareAlike 4.0 International License.