High-risk heart surgery in the heart transplant candidate.

Because of the limited supply of donor hearts, transplant physicians are searching for alternative treatments for patients referred for orthotopic heart transplantation. A group of 20 patients (7% of patients accepted for heart transplantation at Loyola University Medical Center) were nonrandomly sent for conventional heart surgery. Of 20 patients, 17 survived their hospitalization, and 11 of the original 20 have avoided heart transplantation or having their names added to the transplant list. This group represents a high-risk subset of patients. Patients with poor ventricular function and ventricular arrhythmias or with poor ventricular function who underwent first-time revascularization were well served by more conventional heart surgery (all 10 patients survived surgery). Patients with poor ventricular function who required redo bypass operation had a poor result (three of six died), and such patients should be considered carefully for initial heart transplantation.