Heart transplantation overview: Difference between revisions
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The indications for heart transplantation include severe hemodynamic compromise due to [[heart failure]] which equires IV inotropic support to maintain adequate organ perfusion; a peak Vo2 <10 ml/kg/min; NYHA Class IV symptoms not amenable to any other intervention; or recurrence of symptomatic ventricular arrhythmias refractory to all therapeutic intervention. | The indications for heart transplantation include severe hemodynamic compromise due to [[heart failure]] which equires IV inotropic support to maintain adequate organ perfusion; a peak Vo2 <10 ml/kg/min; NYHA Class IV symptoms not amenable to any other intervention; or recurrence of symptomatic ventricular arrhythmias refractory to all therapeutic intervention. | ||
==Historical perspective== | |||
The first [[heart transplant]] into a [[human]] occurred in 1964. The first human-to-human heart transplant was performed by Dr. Christian Barnard in 1967. Norman Shumway performed the first adult human to human heart transplant in the United States. Further developments in the field saw the emergence of standardization of recipient selection [[criteria]], introduction of surveillance [[endocardial biopsy]], distant [[donor]] [[heart]] procurement, and introduction of [[Cyclosporine A]] as an [[immunosuppressive]] regimen. <ref name="KalraSeth2016">{{cite journal|last1=Kalra|first1=Aakshi|last2=Seth|first2=Sandeep|last3=Hote|first3=MilindPadmaker|last4=Airan|first4=Balram|title=The story of heart transplantation: From cape town to cape comorin|journal=Journal of the Practice of Cardiovascular Sciences|volume=2|issue=2|year=2016|pages=120|issn=2395-5414|doi=10.4103/2395-5414.191525}}</ref> | |||
==Classification== | |||
Cardiac Transplantation may be classified according to the surgical procedure performed into Orthotopic procedure and Heterotropic Procedure. <ref name="pmid29492395">{{cite journal| author=Jungschleger JGM, Boldyrev SY, Kaleda VI, Dark JH| title=Standard orthotopic heart transplantation. | journal=Ann Cardiothorac Surg | year= 2018 | volume= 7 | issue= 1 | pages= 169-171 | pmid=29492395 | doi=10.21037/acs.2018.01.18 | pmc=5827120 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29492395 }} </ref> | |||
==Pathophysiology== | |||
The [[pathogenesis]] leading to a [[cardiac transplant]] involves the mechanisms leading up to [[heart failure]]. [[Heart failure]] leads to an inadequate output of the heart to meet the [[metabolic]] demands of the body. Features of chronic heart failure like biventricular [[hypertrophy]], four-chamber [[dilatation]], fibrotic scars, myofibrillar loss, sarcoplasmic vacuolation, [[interstitial fibrosis]] may be seen in the diseased heart. Post-transplantation changes indicating acute or chronic [[rejection]] may be seen. Non-rejection changes include [[coronary artery disease]] (eccentric), Quilty effect, [[interstitial fibrosis]], nodular [[lymphocytic]] endomyocardial infiltrates, and posttransplant [[lymphoproliferative]] disorder in the transplanted heart. <ref name="pmid26776864">{{cite journal| author=Mehra MR, Canter CE, Hannan MM, Semigran MJ, Uber PA, Baran DA | display-authors=etal| title=The 2016 International Society for Heart Lung Transplantation listing criteria for heart transplantation: A 10-year update. | journal=J Heart Lung Transplant | year= 2016 | volume= 35 | issue= 1 | pages= 1-23 | pmid=26776864 | doi=10.1016/j.healun.2015.10.023 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26776864 }} </ref><ref name="pmid1434905">{{cite journal| author=Tazelaar HD, Edwards WD| title=Pathology of cardiac transplantation: recipient hearts (chronic heart failure) and donor hearts (acute and chronic rejection). | journal=Mayo Clin Proc | year= 1992 | volume= 67 | issue= 7 | pages= 685-96 | pmid=1434905 | doi=10.1016/s0025-6196(12)60726-5 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=1434905 }} </ref> | |||
==Causes== | |||
The need for cardiac transplantation may result from advanced, irreversible [[heart failure]] with a severely limited [[life expectancy]]. | |||
Common causes include- Systolic [[Heart Failure]] with a Left Ventricular [[Ejection Fraction]] less than 35%, Ischemic Coronary Artery Disease with Refractory [[Angina]], Intractable life-threatening Arrhythmias, Cardiomyopathies, and congenital Heart Disease. <ref name="pmid25132979">{{cite journal| author=Alraies MC, Eckman P| title=Adult heart transplant: indications and outcomes. | journal=J Thorac Dis | year= 2014 | volume= 6 | issue= 8 | pages= 1120-8 | pmid=25132979 | doi=10.3978/j.issn.2072-1439.2014.06.44 | pmc=4133547 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25132979 }} </ref> <ref name="pmid28779893">{{cite journal| author=Lund LH, Khush KK, Cherikh WS, Goldfarb S, Kucheryavaya AY, Levvey BJ | display-authors=etal| title=The Registry of the International Society for Heart and Lung Transplantation: Thirty-fourth Adult Heart Transplantation Report-2017; Focus Theme: Allograft ischemic time. | journal=J Heart Lung Transplant | year= 2017 | volume= 36 | issue= 10 | pages= 1037-1046 | pmid=28779893 | doi=10.1016/j.healun.2017.07.019 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28779893 }} </ref> | |||
==References== | ==References== | ||
Revision as of 18:53, 9 July 2020
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Editor(s)-in-Chief: C. Michael Gibson, M.S., M.D.; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [1]Ifrah Fatima, M.B.B.S[2]
Overview
Heart transplantation or cardiac transplantation, is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease when medical and device therapy have failed. 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).
Cardiac transplantation is reserved for patients with end-stage congestive heart failure despite all interventions. 1 year survival is 80%, and 5 year survival is 60%. Lifelong immunosuppressive therapy is used to prevent (or postpone) rejection, but increases the risk for opportunistic infections and malignancies.
The indications for heart transplantation include severe hemodynamic compromise due to heart failure which equires IV inotropic support to maintain adequate organ perfusion; a peak Vo2 <10 ml/kg/min; NYHA Class IV symptoms not amenable to any other intervention; or recurrence of symptomatic ventricular arrhythmias refractory to all therapeutic intervention.
Historical perspective
The first heart transplant into a human occurred in 1964. The first human-to-human heart transplant was performed by Dr. Christian Barnard in 1967. Norman Shumway performed the first adult human to human heart transplant in the United States. Further developments in the field saw the emergence of standardization of recipient selection criteria, introduction of surveillance endocardial biopsy, distant donor heart procurement, and introduction of Cyclosporine A as an immunosuppressive regimen. [1]
Classification
Cardiac Transplantation may be classified according to the surgical procedure performed into Orthotopic procedure and Heterotropic Procedure. [2]
Pathophysiology
The pathogenesis leading to a cardiac transplant involves the mechanisms leading up to heart failure. Heart failure leads to an inadequate output of the heart to meet the metabolic demands of the body. Features of chronic heart failure like biventricular hypertrophy, four-chamber dilatation, fibrotic scars, myofibrillar loss, sarcoplasmic vacuolation, interstitial fibrosis may be seen in the diseased heart. Post-transplantation changes indicating acute or chronic rejection may be seen. Non-rejection changes include coronary artery disease (eccentric), Quilty effect, interstitial fibrosis, nodular lymphocytic endomyocardial infiltrates, and posttransplant lymphoproliferative disorder in the transplanted heart. [3][4]
Causes
The need for cardiac transplantation may result from advanced, irreversible heart failure with a severely limited life expectancy. Common causes include- Systolic Heart Failure with a Left Ventricular Ejection Fraction less than 35%, Ischemic Coronary Artery Disease with Refractory Angina, Intractable life-threatening Arrhythmias, Cardiomyopathies, and congenital Heart Disease. [5] [6]
References
- ↑ Kalra, Aakshi; Seth, Sandeep; Hote, MilindPadmaker; Airan, Balram (2016). "The story of heart transplantation: From cape town to cape comorin". Journal of the Practice of Cardiovascular Sciences. 2 (2): 120. doi:10.4103/2395-5414.191525. ISSN 2395-5414.
- ↑ Jungschleger JGM, Boldyrev SY, Kaleda VI, Dark JH (2018). "Standard orthotopic heart transplantation". Ann Cardiothorac Surg. 7 (1): 169–171. doi:10.21037/acs.2018.01.18. PMC 5827120. PMID 29492395.
- ↑ Mehra MR, Canter CE, Hannan MM, Semigran MJ, Uber PA, Baran DA; et al. (2016). "The 2016 International Society for Heart Lung Transplantation listing criteria for heart transplantation: A 10-year update". J Heart Lung Transplant. 35 (1): 1–23. doi:10.1016/j.healun.2015.10.023. PMID 26776864.
- ↑ Tazelaar HD, Edwards WD (1992). "Pathology of cardiac transplantation: recipient hearts (chronic heart failure) and donor hearts (acute and chronic rejection)". Mayo Clin Proc. 67 (7): 685–96. doi:10.1016/s0025-6196(12)60726-5. PMID 1434905.
- ↑ Alraies MC, Eckman P (2014). "Adult heart transplant: indications and outcomes". J Thorac Dis. 6 (8): 1120–8. doi:10.3978/j.issn.2072-1439.2014.06.44. PMC 4133547. PMID 25132979.
- ↑ Lund LH, Khush KK, Cherikh WS, Goldfarb S, Kucheryavaya AY, Levvey BJ; et al. (2017). "The Registry of the International Society for Heart and Lung Transplantation: Thirty-fourth Adult Heart Transplantation Report-2017; Focus Theme: Allograft ischemic time". J Heart Lung Transplant. 36 (10): 1037–1046. doi:10.1016/j.healun.2017.07.019. PMID 28779893.