Heart transplants are still anything but ordinary, but doctors these days have a much better handle on the outcomes for this extraordinary type of surgery.
A long-term study unveiled Monday at the Canadian Cardiovascular Congress in Vancouver looked at heart transplant results since 1984 at the University of Ottawa Heart Institute, covering the followup on a total of 461 patients.
"Despite being a very involved and complicated program, heart transplant is a very successful form of treatment," said Dr. Marc Ruel, surgical director of the heart transplant program at the institute.
Without a transplant, he said the patients would not have lived one more year.
But with a transplant, the survival rate over the period of the study was 86 per cent after one year, 75 per cent at five years, 62 per cent at 10 years, and 36 per cent at 20 years.
Dr, Haissam Haddad, director of Heart Transplantation at the Institute said survival rates over the past 27 years have increased.
"We found out that survival increased significantly especially in patients who had transplant in the last ten years," Haddad said. "So patients who had a heart transplant in the last 10 years survive actually more at one year — as well as five and ten years — and from a medical point of view they do much better than patients who got transplanted in the 1980’s and the 1990’s."
The younger the patient is at the time of the transplant, the more successful the outcome, the study showed.
"We had a patient who was still followed at 25 years and four months, so that's the longest survival we've had, but many patients are still alive well beyond 20 years, and hopefully we'll have solutions to keep them alive for a long time," Ruel said.
The oldest person receiving a heart transplant in the study period was 74, and the youngest was 18.
Transplants can be done after age 65 with good results, but doctors have to carefully make their selections in order to avoid patients with other significant illnesses that would compromise lifespan or quality of life, he said.
Modern heart transplantation became available in 1980, and the study found that survival rates have improved by more than 20 per cent in the years since.
"Eight-year survival since the 2000s is close to 90 per cent; 89.3 per cent to be exact. So this really sets a very high standard for other series to be compared upon," Ruel remarked.
An international registry of heart transplants finds that survival is expected to be about 67 per cent at seven years — so the results in Ottawa compare favourably.
The first human heart transplant was done by Dr. Christiaan Barnard in South Africa in December 1967. The patient lived for 18 days, and died of pneumonia.
The techniques of heart transplantation haven't changed much since the pioneering days, Ruel said, but before-and-after care is much improved.
In particular, post-operative care involves immune suppression, prevention of infections and following patients carefully with biopsies, he said.
"I think having a heart transplant program in the hospital is one of the most complicated things that a hospital can get into. Despite this the results are excellent, and it almost looks as if it is routine. Well, in fact, it is very, very far from routine because of the dozens of levels of involvement that are required for successful transplantation."
He credits donor hospitals, donor procurement and allocation agencies, recipient hospitals, teams of nurses, physiotherapists and transplant cardiologists who keep patients alive by preventing rejection and infection for many years.
The actual surgery normally takes between four and eight hours, Ruel noted. A donor heart remains viable for only four to six hours, so Ottawa transplant surgeons could probably use a heart retrieved from as far away as about Edmonton, "but certainly Vancouver would be stretching it because of the flight time and the need for sometimes refuelling, and the time to implant the heart, which takes between 70 and 90 minutes on average."
Health and Stroke Foundation spokesperson Dr. Beth Abramson said heart transplantation is an excellent treatment for the select few who need it — those with severe, end-stage heart failure.
She urged Canadians to sign their organ donor cards.
Last year, there were 167 heart transplants in Canada, performed in five provinces. At the end of last year, 135 Canadians were on the waiting list for a heart transplant.