Heart transplantation 417958 225026201 2008-07-11T15:01:12Z Newslikeariver 6859883 Removed vandalism "Cranking the lungs out" from intro [[Image:Heart transplant.jpg|thumb|375px|(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 [[organ transplant|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 ([[heart transplantation#Orthotopic procedure|orthotopic procedure]]) or, less commonly, left in to support the donor heart ([[heart transplantation#Heterotopic procedure|heterotopic procedure]]). It is also possible to take a heart from another species ([[xenograft]]), or implant a man-made [[artificial heart|artificial one]], although the outcome of these two procedures has been less successful in comparison to the far more commonly performed [[allograft]]s. ==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 for 90 minutes before stopping. Dr. Hardy had performed the first human [[lung transplant]] the previous year. <ref>[http://www.umc.edu/hardy/ The James D. Hardy Archives<!-- Bot generated title -->]</ref> 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 death|brain dead]] in a car accident. The first successful United States heart 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 was 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 at San Francisco doing heart transplants and research on the rejection phenomenon. In 1984, at two years old, [[Elizabeth Craze]] became the youngest surviving heart transplant patient.<ref>http://www.msnbc.msn.com/id/11275329/</ref><ref>http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2004/04/16/BAG3H668451.DTL</ref> At least the concept of heart transplantation dates back to at least 400 AD in China. The book of [[Liezi]] tells a story of [[Bian Que]] exchanging the hearts of two warriors to balance their personal characteristics.<ref>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.</ref> ==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 for their condition, including medication, should have been considered prior to recommendation. Generally, the following causes of [[heart failure]] can be treated with a heart transplant: *[[Cardiomyopathy]] *[[Congenital heart disease]] *[[Coronary artery disease]] *[[Heart valve]] disease *Life-threatening [[arrhythmia]]s. ==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 [[complication (medicine)|complications]] occurring during the operation: *[[Kidney]], [[lung]], or [[liver]] disease *Insulin-dependent [[diabetes]] with other organ dysfunction *Life-threatening diseases unrelated to [[heart failure]] *[[Vascular disease]] of the neck and leg arteries. ==Procedures== ===Pre-operative=== A typical heart transplantation begins with a suitable donor heart being located from a recently [[deceased]] or [[Brain death|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. 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 [[immunosuppressant]] medication so that their immune system will not reject the new heart. ===Operative=== Once the donor heart has passed its inspection, the patient is taken into the [[operating room]] 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 [[dissect]]ed 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 vein]]s 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 [[suture]]d 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 [[transplant rejection|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 [[Intensive care unit|ICU]] to recover. When they wake up, they will be transferred to a special recovery unit in order to be [[Physical medicine and rehabilitation|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 [[immunosuppressant]] medication to avoid the possibility of [[transplant rejection|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.<ref>{{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}}</ref> 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<ref>http://www.drugs.com/pdr/custodiol-htk-solution.html</ref> to six hours with proper preservation, depending on its starting condition. 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|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.<ref>[http://www.americanheart.org/presenter.jhtml?identifier=4588 Heart Transplants: Statistics] ''The [[American Heart Association]]''. Retrieved February 1, 2007.</ref> * 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 [[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 [[Norman Shumway|Dr. Norman Shumway]], who continued to perform the operation in the U.S. after others abandoned it due to poor results.<ref>[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.</ref>. 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. ==References== {{reflist}} * {{cite web | author=Western Cape government, South Africa | title=Chris Barnard Performs World's First Heart Transplant | url=http://www.capegateway.gov.za/eng/pubs/public_info/C/99478# | date=[[21 February]] [[2005]] | publisher=Cape Gateway | accessdate=2007-01-10}} * {{cite web | author=Department of Cardiothoracic Surgery | title=Patient's Guide to Heart Transplant Surgery | url=http://www.cts.usc.edu/ht-pg-hearttransplantprocedure.html | date= | publisher=University of Southern California | accessdate=2007-01-10}} * {{cite web | author=Nancy Reid | title=Heart transplant: How is it performed? | url=http://health.yahoo.com/ency/healthwise/tx4074abc | date=[[September 22]], [[2005]] | publisher=Healthwise | accessdate=2007-01-10}} * {{cite web | author=Jeffrey Everett | title=Heart Transplant: Indications | url=http://health.allrefer.com/health/heart-transplant-indications.html | date=2003-10-29 | publisher=AllRefer.com | accessdate=2007-01-10}} * {{cite web | author= | title=Hartford Hospital Heart Transplant Program | url=http://www.harthosp.org/transplant/heart.htm#indications | date= | publisher=Hartford Hospital, Connecticut, United States | accessdate=2007-01-10}} <!--http://www.americanheart.org/presenter.jhtml?identifier=4588 this link as of 2006-01-10 is broken. Without full citation details, unable to search for any web archive of page--> ==External links== *[http://www.heartofcapetown.co.za Official Heart Transplant Museum - Heart Of Cape Town] {{Cardiac surgery}} {{Organ transplantation}} [[Category:transplantation medicine]] [[de:Herztransplantation]] [[es:Trasplante de corazón]] [[fr:Transplantation cardiaque]] [[hu:Szívátültetés]] [[nl:Harttransplantatie]] [[ja:心臓移植]] [[pt:Transplante de coração]] [[ru:Пересадка сердца]] [[simple:Heart transplant]] [[uk:Трансплантація серця]]