HEART TRANSPLANTATION AND ITS MANAGEMENT
BY SHABNAM JAHAN MPTh-II Yr
• A heart transplant is a surgical procedure performed to
remove the diseased heart from a patient and replace it with a healthy one from an organ donor.1
• In order to remove the heart from the donor, two or more
physicians must declare the donor brain-dead1
• Worldwide, about 3,500 heart transplants are performed
• Post-operation survival periods now average 15 years.2
• The first successful heart transplant was done in South
Africa in 1967 by Dr. Christian Barnard; and the patient only lived for 18 days.
• The second operation was also performed in South
Africa in January 1968 and the patient lived for 18 months.
• Between then and middle of 1969, 135 further cardiac
transplant were carried out in 60 centre's throughout the world but the survival rate did ...view middle of the document...
Venugopal in AIIMS in 1994.
A heart transplant treats irreversible heart failure when other treatment options fail. Heart transplants are performed for several types of cardiac illness, including:
• Cardiomyopathy, an illness that damages the • • • •
heart muscle (47%) Severe coronary artery disease (about 42% of cases) Complex forms of Congenital heart defects (8%) Re-Transplantation (about 3%) Irreparably damaged heart valves (2%)
Absolute & Relative Contraindications
At present, the only absolute contraindications for Heart Transplant appear to be:
• Presence of irreversible end-organ diseases • Presence of severe pulmonary hypertension
• Presence of a recent intracranial
cerebrovascular event with significant persistent deficit • Presence of systemic diseases • Presence of active malignancy or infections
Relative contraindications include the following: 5
• Uncontrolled diabetes mellitus with significant • • • •
neuropathy, nephropathy, or retinopathy Severe asymptomatic peripheral vascular disease Patients with body mass index > or = 35 Psychological impairment Drug dependency that is felt to limit the allograft survival or limit the patient's chance for meaningful recovery
• Active alcohol • Lack of social support network that can make
long term commitment for patient's welfare.
• Cigarette smoking when the patient makes no
attempt to stop.
• Unrealistic expectations by the patient or family
regarding transplant, its risks, and benefits.5
In order to undertake transplantation it is essential that the recipient be assessed before acceptance into the transplant programme:3 • End-stage heart disease with life expectancy limited to 612 months.6
• There is no upper or lower age limit when considering a
patient for heart transplantation even those aged 60 yrs.
• Absence of irreversible hepatic or renal failure • Absence of active infection • Psychosocial stability
• The patient should have a strong motivation to survive.
Organ donors are individuals who are declared “brain dead” due to a severe brain injury.4 Other points to be considered include: • age (