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Information about Heart Transplantation

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Diagram illustrating the placement of a donor heart in an orthotopic procedure. Notice how the back of the patient's left atrium and great vessels are left in place.
Heart transplantation or cardiac transplantation, is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease. The most common procedure is to take a working heart from 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.

History

The first heart transplanted into a human occurred in 1964 at the University of Mississippi Medical Center in Jackson, Mississippi when a team led by Dr. James Hardy transplanted a chimpanzee heart into a dying patient. The heart beat 90 minutes before stopping. Dr. James Hardy had performed the first human lung transplant the previous year. [1] The first human to human heart transplant was performed by Professor Christiaan Barnard at Groote Schuur Hospital in December 1967. The patient was a Louis Washkansky of 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.

Indications

In order for a patient to be recommended for a heart transplant they will generally have advanced, irreversible heart failure with a severely limited life expectancy. Other possible treatments, including medication, for their condition should have been considered or attempted prior to recommendation. Generally, the following causes of heart failure can be treated with a heart transplant:

Contraindications

Some patients are less suitable for a heart transplant, especially if they suffer from other circulatory conditions unrelated to the heart. The following conditions in a patient would increase the chances of complications occurring during the operation:

Procedures

Pre-operative

A typical heart transplantation begins with a suitable donor heart being located from a recently deceased or brain dead donor. The transplant patient is contacted by a nurse coordinator 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.

Operative

Once the donor heart has passed its inspection, the patient is taken into the operating theatre and given a general anesthetic. Either an orthotopic or a heterotopic procedure is followed, depending on the condition of the patient and the donor heart.

Orthotopic procedure

The orthotopic procedure begins with the surgeons performing a median sternotomy to expose the mediastinum. The pericardium is opened, the great vessels are dissected and 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 great vessels and sutured in place. The new heart is restarted, the patient is weaned from cardiopulmonary bypass and the chest cavity is closed.

Heterotopic procedure

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 pulmonary hypertension).

Post-operative

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. 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 immunosuppressant medication to avoid the possibility of rejection. Since the vagus nerve is severed during the operation, the new heart will beat at around 100 bpm until nerve regrowth occurs.

'Living organ' transplant

Doctors made medical history in February 2006, at Bad Oeynhausen Clinic for Thorax- and Cardiovascular Surgery, Germany, when they successfully transplanted a 'beating heart' into a patient.[2] Normally a donor's heart is injected with potassium chloride in 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 to six hours, depending on its condition to start with. Rather than cooling the heart, this new procedure involves keeping it at body temperature and 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.

Prognosis

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.[3]
  • 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 2006, Tony Huesman is the world's longest living heart transplant patient, having survived for 28 years with a transplanted heart. Huesman received a heart in 1978 at the age of 20 after viral pneumonia severely weakened his heart. The operation was performed at Stanford University under 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.[4]

References

Footnotes

1. ^ [1]
2. ^ "Bad Oeynhausen Clinic for Thorax- and Cardiovascular Surgery Announces First Successful Beating Human Heart Transplant", TransMedics, 23 February 2006. Retrieved on 2007-05-14. 
3. ^ Heart Transplants: Statistics The American Heart Association. Retrieved February 1, 2007.
4. ^ Heart Transplant Patient OK After 28 Yrs (September 14, 2006) CBS News. Retrieved December 29, 2006.


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Health Science – Medicine - Surgery - Cardiac surgery
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Organ transplantation
Types
Organs and tissues
Related topics
Organizations
People
organ transplant is the moving of a whole or partial organ from one body to another (or from a donor site on the patient's own body), for the purpose of replacing the recipient's damaged or failing organ with a working one from the donor site.
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Heart failure
Classification & external resources

ICD-10 I 50.0
ICD-9 428.0

DiseasesDB 16209
MedlinePlus 000158
eMedicine med/3552  
MeSH D006333

Congestive heart failure (CHF), also called
..... Click the link for more information.
Coronary heart disease
Classification & external resources

ICD-10 I20-I25
ICD-9 410 - 414 , 429.2

Coronary heart disease (CHD), also called coronary artery disease (CAD), ischaemic heart disease, atherosclerotic heart disease, is the end result
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heart is a muscular organ responsible for pumping blood through the blood vessels by repeated, rhythmic contractions, or a similar structure in the annelids, mollusks, and arthropods.
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Organ donation is the removal of the tissues of the human body from a person who has recently died, or from a living donor, for the purpose of transplanting or grafting them into other persons.
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An allograft or allogeneic transplant refers to when transplanted cells, tissues or organs are sourced from a genetically non-identical member of the same species. Most human tissue and organ transplants are allografts.
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Xenotransplantation (xeno- from the Greek meaning "foreign") is the transplantation of living cells, tissues or organs from one species to another such as from pigs to humans (see Medical grafting).
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artificial heart is a prosthetic device that is implanted into the body to replace the biological heart. It is distinct from a cardiopulmonary bypass machine (CPB), which is an external device used to provide the functions of both the heart and the lungs.
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An allograft or allogeneic transplant refers to when transplanted cells, tissues or organs are sourced from a genetically non-identical member of the same species. Most human tissue and organ transplants are allografts.
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19th century - 20th century - 21st century
1930s  1940s  1950s  - 1960s -  1970s  1980s  1990s
1961 1962 1963 - 1964 - 1965 1966 1967

Also Nintendo emulator: 1964 (emulator).

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University of Mississippi Medical Center (UMC) is the health sciences campus of the University of Mississippi (Ole Miss). Located in Jackson, Mississippi (USA), it houses the Schools of Medicine, Dentistry, Nursing, Health Related Professions, and Graduate Studies in the Health
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Lung transplantation is a surgical procedure in which a patient's diseased lungs are partially or totally replaced by lungs which come from a donor. While lung transplants carry certain associated risks, they can also extend life expectancy and enhance the quality of life for
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Christiaan Neethling Barnard (November 8, 1922 – September 2, 2001) was a South African cardiac surgeon. He is famous for performing the world's first successful human-to-human heart transplant.
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This article or section needs sources or references that appear in reliable, third-party publications. Alone, primary sources and sources affiliated with the subject of this article are not sufficient for an accurate encyclopedia article.
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19th century - 20th century - 21st century
1930s  1940s  1950s  - 1960s -  1970s  1980s  1990s
1964 1965 1966 - 1967 - 1968 1969 1970

Year 1967 (MCMLXVII
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Louis Washkansky (1913 – 21 December 1967) was the recipient of the world's first human heart transplant.

Washkansky was a Lithuanian Jew, who migrated with his friends to South Africa in 1922, aged nine, and became a grocer in Cape Town.
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Cape Town
Kaapstad, iKapa
Panorama of the Cape Town city bowl from the Waterfront to Table Mountain

Flag
Nickname: The mother city, or The Tavern of the Seas
Motto:
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Pneumonia
Classification & external resources

ICD-10 J 12. , J 13. , J 14. , J 15. , J 16. , J 17. , J 18. , P 23.
ICD-9 480 - 486 , 770.0

DiseasesDB 10166

eMedicine topic list

MeSH C08.381.
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Denise Ann Darvall (1943–3 December 1967) was the donor in the world’s first successful human heart transplant, performed at Groote Schuur Hospital, South Africa, by a team of surgeons led by Professor Christiaan Barnard.
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Brain death is a legal definition of death that emerged in the 1960's as a response to the ability to resuscitate individuals and mechanically keep the heart and lungs working. In simple terms, brain death is the irreversible end of all brain activity.
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Heart failure
Classification & external resources

ICD-10 I 50.0
ICD-9 428.0

DiseasesDB 16209
MedlinePlus 000158
eMedicine med/3552  
MeSH D006333

Congestive heart failure (CHF), also called
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Homo.
Upper Paleolithic 33 At age 15: 39 (to age 54)[3][4]
Neolithic 20  
Bronze Age 18[5]  
Classical Greece 25-45  
Classical Rome 25-45  
Medieval Britain 20-30  
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Heart failure
Classification & external resources

ICD-10 I 50.0
ICD-9 428.0

DiseasesDB 16209
MedlinePlus 000158
eMedicine med/3552  
MeSH D006333

Congestive heart failure (CHF), also called
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MeSH D009202 Cardiomyopathy, which literally means "heart muscle disease", is the deterioration of the function of the myocardium (i.e., the actual heart muscle) for any reason. People with cardiomyopathy are often at risk of arrhythmia or sudden cardiac death or both.
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Congenital heart disease (CHD) is heart disease in the newborn, and includes structural defects, congenital arrythmias, and cardiomyopathies. CHD is a defect of the heart that exists primarily at birth, and can describe a wide variety of different abnormalities affecting the heart.
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Coronary heart disease
Classification & external resources

ICD-10 I20-I25
ICD-9 410 - 414 , 429.2

Coronary heart disease (CHD), also called coronary artery disease (CAD), ischaemic heart disease, atherosclerotic heart disease, is the end result
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In anatomy, the heart valves are valves in the heart that maintain the unidirectional flow of blood by opening and closing depending on the difference in pressure on each side. The mechanical equivalent of the heart valves would be the reed valves.
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Cardiac arrhythmia
Classification & external resources

Ventricular Fibrillation or V-Fib, an example of cardiac arrhythmia.
ICD-10 I 47. - I 49.
ICD-9 427

DiseasesDB 15206
MedlinePlus 001101

MeSH D001145 Cardiac arrhythmia
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Circulatory System is a psychedelic rock musical ensemble formed by musician/painter Will Cullen Hart, and featuring Hannah Jones, Derek Almstead, Peter Erchick, John Fernandes, and Heather McIntosh.
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