- Heart transplantation
Heart transplantation or cardiac transplantation, is a surgical transplant procedure performed on patients with end-stage
heart failureor severe coronary artery disease. The most common procedure is to take a working heartfrom a recently deceased organ donor( allograft) and implant it into the patient. The patient's own heart may either be removed (orthotopic procedure) or, less commonly, left in to support the donor heart (heterotopic procedure). It is also possible to take a heart from another species ( xenograft), or implant a man-made artificial one, although the outcome of these two procedures has been less successful in comparison to the far more commonly performed allografts.
The first heart transplanted into a human occurred in
1964at the University of Mississippi Medical Centerin Jackson, Mississippi when a team led by Dr. James Hardy transplanted a chimpanzee heart into a dying patient. The heart beat for 70 minutes before stopping. Dr. Hardy had performed the first human lung transplantthe previous year. [ [http://www.umc.edu/hardy/ The James D. Hardy Archives ] ] The first human to human heart transplant was performed by Professor Christiaan Barnardat Groote Schuur Hospitalin December 1967. The patient was a Louis Washkanskyof Cape Town, South Africa, who lived for 18 days after the procedure before dying of pneumonia. The donor was Denise Darvall, who was rendered brain dead in a car accident. The first successful United States heart transplant was done at Stanford Universityby doctor Norman E. Shumwayin January, 1968. Subsequently, another transplant was done at St. Lukes hospital in Houston Texas by Denton Cooley, M. D. in June 1968. The donor was a teenage suicide victim (who had had an aortic coarctation repaired as a young child, also by Dr. Cooley) and the recipient, Mr. Thomas, had terminal severe cardiomyopathy. He survived 8 months before dying of rejection of the transplanted heart. A series of five subsequent heart transplants were done that month by Dr. Cooley followed by a number of transplants in Houston that year before the program was canceled, leaving only Norman Shumway at Stanford University doing heart transplants and research on the rejection phenomenon. In 1984, at two years old, Elizabeth Crazebecame the youngest surviving heart transplant patient. [ [http://www.msnbc.msn.com/id/11275329/ Heart transplant pioneer Shumway dies - Heart health - MSNBC.com ] ] [ [http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2004/04/16/BAG3H668451.DTL STANFORD UNIVERSITY / A reunion of hearts, minds - and lungs / Transplant recipients, caregivers celebrate survival against the odds ] ]
At least the concept of heart transplantation dates back to at least 400 AD in China. The book of
Liezitells a story of Bian Queexchanging the hearts of two warriors to balance their personal characteristics. [Kahan BD. Pien Ch'iao, the legendary exchange of hearts, traditional Chinese medicine, and the modern era of cyclosporine. Transplant Proc. 1988 Apr;20(2 Suppl 2):2-12.]
In order for a patient to be recommended for a heart transplant they will generally have advanced, irreversible
heart failurewith a severely limited life expectancy. Other possible treatments for their condition, including medication, should have been considered prior to recommendation. Generally, the following causes of heart failurecan be treated with a heart transplant:
Congenital heart disease
Coronary artery disease
Heart valvediseaseLife-threatening arrhythmias.
Some patients are less suitable for a heart transplant, especially if they suffer from other
circulatoryconditions unrelated to the heart. The following conditions in a patient would increase the chances of complications occurring during the operation:
Kidney, lung, or liverdisease
diabeteswith other organ dysfunction
*Life-threatening diseases unrelated to
Vascular diseaseof the neck and leg arteries.
A typical heart transplantation begins with a suitable donor heart being located from a recently
deceasedor brain dead donor. The transplant patient is contacted by a nursecoordinator and instructed to attend the hospital in order to be evaluated for the operation and given pre-surgical medication. At the same time, the heart is removed from the donor and inspected by a team of surgeons to see if it is in a suitable condition to be transplanted. Occasionally it will be deemed unsuitable. This can often be a very distressing experience for an already emotionally unstable patient, and they will usually require emotional support before being sent home.The patient must also undergo many emotional, psychological, and physical tests to make sure that they are in good mental health and will make good use of their new heart. The patient is also given immunosuppressantmedication so that their immune system will not reject the new heart.
Once the donor heart has passed its inspection, the patient is taken into the
operating roomand given a general anesthetic. Either an orthotopic or a heterotopic procedure is followed, depending on the condition of the patient and the donor heart.
The orthotopic procedure begins with the surgeons performing a
median sternotomyto expose the mediastinum. The pericardiumis opened, the great vesselsare dissected and the patient is attached to cardiopulmonary bypass. The failing heart is removed by transecting the great vessels and a portion of the left atrium. The pulmonary veins are not transected; rather a circular portion of the left atrium containing the pulmonary veins is left in place. The donor heart is trimmed to fit onto the patients remaining left atrium and the great vessels are sutured in place. The new heart is restarted, the patient is weaned from cardiopulmonary bypass and the chest cavity is closed.
In the heterotopic procedure, the patient's own heart is not removed before implanting the donor heart. The new heart is positioned so that the chambers and blood vessels of both hearts can be connected to form what is effectively a 'double heart'. The procedure can give the patients original heart a chance to recover, and if the donor's heart happens to fail (eg. through rejection), it may be removed, allowing the patients original heart to start working again. Heterotopic procedures are only used in cases where the donor heart is not strong enough to function by itself (due to either the patients body being considerably larger than the donor's, the donor having a weak heart, or the patient suffering from
The patient is taken into ICU to recover. When they wake up, they will be transferred to a special recovery unit in order to be rehabilitated. How long they remain in hospital post-transplant depends on the patient's general health, how well the new heart is working, and their ability to look after their new heart. Doctors typically like the new recipients to leave hospitals soon after surgery because of the risk of infection in a hospital (typically 1 - 2 weeks without any complications). Once the patient is released, they will have to return to the hospital for regular check-ups and rehabilitation sessions. They may also require emotional support. The number of visits to the hospital will decrease over time, as the patient adjusts to their transplant. The patient will have to remain on lifetime
immunosuppressantmedication to avoid the possibility of rejection. Since the vagus nerveis severed during the operation, the new heart will beat at around 100 bpmuntil nerve regrowthoccurs.
'Living organ' transplant
Doctors made medical history in February
2006, at Bad OeynhausenClinic for Thorax- and Cardiovascular Surgery, Germany, when they successfully transplanted a 'beating heart' into a patient. [cite news | author= | title=Bad Oeynhausen Clinic for Thorax- and Cardiovascular Surgery Announces First Successful Beating Human Heart Transplant | url=http://www.transmedics.com/wt/page/pr_1140714229 | date= 23 February 2006| publisher=TransMedics | accessdate=2007-05-14] Normally a donor's heart is injected with potassium chloridein order to stop it beating, before being removed from the donor's body and packed in ice in order to preserve it. The ice can usually keep the heart fresh for a maximum of four [ [http://www.drugs.com/pdr/custodiol-htk-solution.html Custodiol Htk Solution patient advice including side effects ] ] to six hours with proper preservation, depending on its starting condition. Rather than cooling the heart, this new procedure involves keeping it at body temperatureand hooking it up to a special machine called an Organ Care System that allows it to continue beating with warm, oxygenated blood flowing through it. This can maintain the heart in a suitable condition for much longer than the traditional method.
The prognosis for heart transplant patients following the orthotopic procedure has greatly increased over the past 20 years, and as of Aug. 11, 2006, the survival rates were as follows. [ [http://www.americanheart.org/presenter.jhtml?identifier=4588 Heart Transplants: Statistics] "The
American Heart Association". Retrieved February 1, 2007.]
* 1 year: 86.1% (males), 83.9% (females)
* 3 years: 78.3% (males), 74.9% (females)
* 5 years: 71.2% (males), 66.9% (females)
As of the end of 2007, Tony Huesman is the world's longest living heart transplant patient, having survived for 29 years with a transplanted heart. Huesman received a heart in
1978at the age of 20 after viral pneumoniaseverely weakened his heart. The operation was performed at Stanford Universityunder American heart transplant pioneer Dr. Norman Shumway, who continued to perform the operation in the U.S. after others abandoned it due to poor results. [ [http://www.cbsnews.com/stories/2006/09/14/ap/health/mainD8K49NG86.shtml Heart Transplant Patient OK After 28 Yrs] (September 14, 2006) "CBS News". Retrieved December 29, 2006.] . Another noted heart transplant recipient, Kelly Perkins, climbs mountains around the world to promote positive awareness of organ donation. Perkins is the very first heart transplant recipient to climb to the peaks of Mt. Fuji, Mt. Kilimanjaro, the Matterhorn, Mt. Whitney, and Cajon de Arenales in Argentina in 2007, 12 years after her transplant surgery. Dwight Kroening is yet another noted recipient promoting positive awareness for organ donation. Twenty two years after his heart transplant, he is the first to finish an Ironman competition. [ [http://www.youtube.com/watch?v=5RuijhlU8aU Dwight Kroening first heart transplant to do ironman] Retrieved August 27, 2008.]
* [http://www.childrens.com/Specialties/template.cfm?groupid=2&pageid=46 Heart Transplant at Children's Medical Center]
* [http://www.heartofcapetown.co.za Official Heart Transplant Museum - Heart Of Cape Town]
* [http://www.flickr.com/photos/stanfordmedicine/2849110708/ Photograph of first U.S. heart transplant]
Wikimedia Foundation. 2010.
Look at other dictionaries:
Heart–lung transplant — Intervention ICD 9 CM 33.6 MeSH … Wikipedia
Transplantation du cœur — Transplantation cardiaque Schéma d un coeur transplanté La greffe cardiaque, ou transplantation cardiaque, est une intervention chirurgicale consistant à remplacer un cœur malade par un cœur sain, prélevé sur un donneur. Sommaire … Wikipédia en Français
Heart failure — Classification and external resources The major signs and symptoms of heart failure. ICD 10 I5 … Wikipedia
Heart valve repair — Intervention ICD 9 CM 35.0 35.2 Heart valve repair is a surgical technique used to fix defects in … Wikipedia
Transplantation cardiaque — Schéma d un cœur transplanté La greffe cardiaque, ou transplantation cardiaque, est une intervention chirurgicale consistant à remplacer un cœur malade par un cœur sain, prélevé sur un donneur. Sommaire … Wikipédia en Français
Heart-lung transplant — Interventions infobox Name = PAGENAME Caption = ICD10 = ICD9 = 33.6 MeshID = D016041 OtherCodes = A heart lung transplant is a procedure carried out to replace both heart and lungs in a single operation. Due to a shortage of suitable donors, it… … Wikipedia
Heart disease — Infobox Disease Name = PAGENAME Caption = DiseasesDB = ICD10 = ICD9 = ICDO = OMIM = MedlinePlus = eMedicineSubj = |oo eMedicineTopic = MeshID = D006331 Heart disease is an umbrella term for a variety for different diseases affecting the heart. As … Wikipedia
Transplantation, cross-species — Transplantation from one species to a foreign one. Known medically as xenotransplanation. The rationale for this type of transplantation has been the short supply of human organs. Perhaps the most famous case of cross species transplantation was… … Medical dictionary
transplantation — Implanting in one part a tissue or organ taken from another part or from another individual. SEE ALSO: graft. [L. transplanto, pp. atus, to transplant] bone marrow t. grafting of bone marrow tissue … Medical dictionary
transplantation — n. the implantation of an organ or tissue (see graft) from one part of the body to another or from one person (the donor) to another (the recipient). Success for transplantation depends on the degree of compatibility between donor and graft: it… … The new mediacal dictionary