Heart Transplantation After Cardioverter - Defibrillator lmplantation

A case control study was performed to determine whether previous implantable cardioverter-defibrillator(ICD)insertion adversely affects outcome after heart transplantation. Six male heart transplant recipients who had undergone lCD insertion 12 ±5 months before heart transplantation were compared to a cohort ofsix heart transplant recipients who were matched according to age, preoperative status and hemodynamics, date of transplantation, graft ischemic time, history of a previous cardiac operation, and duration of follow-up. There were no significant differences in operating room time, chest tube drainage, time to extubation, and the duration ofintensive care unit or hospital stay between the two groups. Furthermore, there were no significant differences in the number of units of packed cells, fresh frozen plasma, platelets and cryoprecipitate transfused. The number of treated rejection episodes and the number ofpatients requiring intravenous antibiotics for infection in the first 90 days was identical between groups. It was concluded that heart transplantation after lCD implantation did not appear to carry more risk than heart transplantation after a previous cardiac operation. Our limited experience supports the potential use ofthe lCD in patients with life-threatening ventricular dysrhythmias who are awaiting transplantation. (Chest 1993; 103:1710-14)