The operation of choice for primary pulmonary hypertension remains controversial. Heart-lung transplantation, single-lung transplantation, and double-lung transplantation have all been advocated. In order to examine this issue further, we reviewed our institution's experience with heart-lung transplantation for primary pulmonary hypertension. Between 1981 and July 1995, 39 patients underwent heart-lung transplantation for primary pulmonary hypertension. The average age of the patients was 32 years, and there were 25 females and 14 males. Waiting time for transplantation averaged 288 days. Follow-up was 100% complete through July 1997. Operative (30-day) mortality was 18%. Actuarial analysis was performed to determine survival, freedom from rejection, freedom from obliterative bronchiolitis, freedom from obliterative bronchiolitis-related death, and freedom from accelerated graft-coronary disease, with the results shown below:

The most frequent causes of death were infection (N=5), obliterative bronchiolitis (N=4), and accelerated graft coronary disease (N=4). Functional status of the 14 patients currently alive included 11 in NYHA heart failure class I, 3 in class II, and none in class III or class IV.

These data show that heart-lung transplantation results in survival comparable to that reported following single or double lung transplantation. They also suggest that obliterative bronchiolitis, while remaining a significant cause of late death, occurs less commonly than with lung transplantation alone, and that accelerated is rare in the first five years following transplantation.