Cardiac transplantation

Cardiac Transplantation

Cardiac transplantation, also known as heart transplantation, is a surgical procedure that involves replacing a patient's diseased or failing heart with a healthy heart from a deceased donor. This procedure is typically reserved for patients with end-stage heart failure or severe coronary artery disease who have not responded to other treatments.

History

The first successful human heart transplant was performed by Dr. Christiaan Barnard in 1967 in South Africa. Since then, advances in surgical techniques, immunosuppressive drugs, and patient management have significantly improved the outcomes of heart transplantation.

Indications

Heart transplantation is indicated for patients with:

• End-stage heart failure
• Severe coronary artery disease
• Congenital heart defects
• Cardiomyopathy

Patients are carefully evaluated to determine their eligibility for transplantation, considering factors such as overall health, age, and the presence of other medical conditions.

Procedure

The heart transplantation procedure involves several key steps:

Donor Heart Procurement

The donor heart is obtained from a deceased donor who has been declared brain dead. The heart is preserved in a cold solution to maintain its viability during transport.

Recipient Preparation

The recipient is placed under general anesthesia, and the chest is opened through a median sternotomy. The patient is connected to a cardiopulmonary bypass machine to maintain circulation and oxygenation during the surgery.

Heart Implantation

The diseased heart is removed, and the donor heart is sewn into place. The major blood vessels are connected, and the heart is gradually warmed and restarted.

Postoperative Care

After surgery, patients require intensive monitoring and care. They are placed on immunosuppressive medications to prevent rejection of the donor heart. Regular follow-up visits and tests, such as echocardiography and endomyocardial biopsy, are necessary to monitor heart function and detect any signs of rejection.

Complications

Potential complications of heart transplantation include:

• Rejection of the donor heart
• Infection due to immunosuppression
• Coronary artery vasculopathy
• Side effects of immunosuppressive drugs

Prognosis

The prognosis for heart transplant recipients has improved significantly over the years. The average survival rate is approximately 85% at one year and 75% at five years post-transplant. Long-term survival depends on factors such as age, underlying health conditions, and adherence to medical therapy.

Also see

• Heart failure
• Immunosuppressive drug
• Organ transplantation
• Cardiomyopathy