Clinical perspectives of patients with Chagas cardiomyopathy listed as high priority for heart transplantation

Introduction: Heart failure deterioration is responsible for elevated mortality rates in the heart transplantation waiting lists. In Chagas cardiomyopathy, the presence of biventricular dysfunction increases the severity of this complication. Method: We studied 141 patients with cardiogenic shock, listed in priority for heart transplantation. Forty six patients presented Chagas cardiomyopathy and 95 other cardiomyopathies. Heart failure deterioration was treated with intravenous inotropic drugs and intra-aortic balloon pump insertion. Five patients with Chagas disease underwent paracorporeal left ventricular assist device implantation. Results: During a mean follow-up of 2.8 months, 58 (41.1%) of the 141 patients were transplanted, while 73 (53.7%) died and 10 were removed from the waiting list. The mortality of chagasic and non chagasic patients were 45.6% and 54.7%, respectively. Otherwise, the median survival expectation of patients with Chagas disease, without the heart transplantation performance, was only 1.5 months, and these patients presented a relative risk of mortality of 1.6 in relation to patients with other cardiomyopathies (p<0.05). The five patients submitted to left ventricular assist device implantation were maintained under support for a mean of 22 days. Two of them were transplanted, two died due to multiple organ failure and one still under circulatory support. None of these patients presented right ventricular dysfunction and there were no device related complications. Conclusion: The evolution of heart failure deterioration seems to be rapid in patients with Chagas cardiomyopathy. Therefore, it is important the precocious indication of mechanical circulatory support as a bridge to heart transplantation in these patients. Descriptors: Chagas cardiomyopathy. Shock, cardiogenic. Heart transplantation. Heart assist devices.