Introduction: The most efficacious treatment for end-stage cardiac failure is cardiac transplantation. Cardiac transplantation has been performed at our center since 2003. This article presents our 21 years’ clinical experience in patients who have undergone orthotopic cardiac transplantation with regard to perioperative anesthetic management and postoperative survival.
Methods: Medical records and anesthetic charts of all patients with end-stage cardiac failure who had undergone cardiac transplantation between 2003 and 2024 were reviewed. Information related to the demographic profile, preoperative evaluation, anesthetic management and perioperative complications were collected and analyzed.
Results: Sixty-nine patients with end-stage cardiac failure received general anesthesia for cardiac transplantation within 21-year period. 65.2% of the patients were male. The patients had a history of nonischemic cardiomyopathy (14.5%), ischemic cardiomyopathy (37.7%), congenital (44.9%) or idiopathic reasons (2.9%). The mean age of the patients was 29.0±17.3 years. 36.2% of them had undergone previous cardiac surgery. Upon preoperative echocardiography the mean ejection fraction was 28.0 ± 3.2%. 8.7 % of the patients had left ventricular assist device (LVAD) as a bridge to transplantation. HTK solution was used for protection of donor hearts. Mean ischemia time was 251.2 ± 62.7 minutes. Postoperatively, in the early 48 hours; the need for ECMO and IABP support was 18.8 and 5.8% respectively. 24.6% of patients had revision cardiac surgery. Postoperatively, the patients stayed in ICU for 11.6 ± 5.6 days with a mean duration of 35.2 hours of mechanical ventilation The mean stay at hospital was 19.4 ±10.8 days. For the first 28 days,  mortality rate was 21.7% (15 patients), while it was 53.6% (37 patients) currently.
Conclusion: Despite the low number of donor hearts in our country, cardiac transplantation has continously being performed since 2003 at our center.  It is the definitive and effective treatment for end stage cardiac failure patients. The cooperation between surgical and anesthesia teams, rich surgical and cardiac anesthesia experiences, developments in immunosuppresive therapy and meticulous postoperative ICU management play key roles in the success of these operations.