A long-term study unveiled Monday at the Canadian Cardiovascular Congress in Vancouver found that heart-transplant survival rates were 86 per cent after one year.
The study, which looked at results since 1984 at the University of Ottawa Heart Institute, and covered the follow-up on 461 patients, also found that the younger the patient at the time of the transplant, the more successful the outcome.
"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 patients would not have lived one more year. With a transplant, the study revealed the survival rate was 75 per cent at five years, 62 per cent at 10 years, and 36 per cent at 20 years.
"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," Dr. 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 the age of 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.
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.
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," Dr. Ruel said.
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 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, Dr. Ruel said, but before-and-after care is much improved.
In particular, postoperative 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, Dr. 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."
Heart 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.