The first heart transplant operation. Features, indications and contraindications for heart transplant surgery

Heart transplantation has become an established treatment for end-stage heart failure. Candidates for heart transplantation are patients in whom conservative therapy is ineffective, and other surgical methods for correcting heart disease are not indicated due to insufficient myocardial function.

Key considerations in heart transplantation are evaluation and selection of recipients, as well as postoperative management and immunosuppression. Consistent implementation of these steps in accordance with heart transplant protocols is the key to the success of the operation.

History of heart transplant

First successful transplant human heart was made by Christian Barnard in South Africa in 1967. Early research in this area were carried out by scientists in various countries: Frank Mann, Marcus Wong in the USA, V.P. Demikhov in the USSR. Success early operations was limited by the imperfection of technology and equipment for artificial blood circulation, and insufficient knowledge in immunology.

A new era in transplantology began in 1983 with the beginning of the clinical use of cyclosporine. This increased survival rates, and heart transplants began to be performed in various centers around the world. In Belarus, the first heart transplant was performed in 2009. The main limitation to transplantation worldwide is the number of donor organs.

A heart transplant is an operation to replace the heart of a patient with end-stage heart failure with a heart from a suitable donor. This operation is performed on patients with a survival prognosis of less than one year.

In the United States, the annual heart transplant rate for patients with heart failure is about 1%.

Diseases for which heart transplants are performed:

Dilated cardiomyopathy – 54%

Ischemic cardiomyopathy with coronary disease hearts - 45%

Congenital heart pathology and other diseases – 1%

Pathophysiology of heart transplantation

Pathophysiological changes in the heart in patients requiring heart transplantation depend on the cause of the disease. Chronic ischemia causes damage to cardiomyocytes. In this case, a progressive increase in the size of cardiomyocytes, their necrosis and scar formation develops. The pathophysiological process of coronary heart disease can be influenced by selected therapy (cardioprotective, antiplatelet, hypolipidemic), performing coronary artery bypass grafting and angioplasty with stenting. In this case, it is possible to slow down the progressive loss of heart muscle tissue. There are also cases of damage to the distal coronary bed; in these cases, surgical treatment is ineffective, the function of the heart muscle gradually decreases, and the cavities of the heart expand.

The pathological process underlying dilated cardiomyopathy has not yet been studied. Apparently, the deterioration of myocardial function is influenced by mechanical enlargement of cardiomyocytes, dilation of the heart cavities and depletion of energy reserves.

Pathophysiological changes in a transplanted heart have their own characteristics. Denervation of the heart during transplantation leads to the fact that the heart rate is regulated only humoral factors. As a result of reduced innervation, some myocardial hypertrophy develops. The function of the right heart in the postoperative period directly depends on the time of graft ischemia (from cross-clamping of the aorta during donor heart collection to reimplantation and reperfusion) and the adequacy of protection (perfusion of the preservative solution, temperature in the container). The right ventricle is very sensitive to damaging factors and in the early postoperative period may remain passive and not perform any work. Within a few days, its function may be restored.

Pathophysiological changes include rejection processes: cellular and humoral rejection. Cellular rejection is characterized by perivascular lymphocytic infiltration and, in the absence of treatment, subsequent myocyte damage and necrosis. Humoral rejection is much more difficult to describe and diagnose. Humoral rejection is thought to be mediated by antibodies that deposit in the myocardium and cause cardiac dysfunction. The diagnosis of humoral rejection is mainly clinical and is a diagnosis of exclusion, since endomyocardial biopsy in these cases is not very informative.

A late process characteristic of cardiac allografts is atherosclerosis coronary arteries. The process is characterized by hyperplasia of the intima and smooth muscles of small and medium-sized vessels and is diffuse in nature. The causes of this phenomenon are often unknown, but cytomegalovirus infection (CMV infection) and rejection are thought to play a role. This process is thought to depend on the release of growth factor into the allograft by circulating lymphocytes. There is currently no treatment for this condition other than a repeat heart transplant.

Clinical picture

Candidates for heart transplantation are patients with heart failure of classes III-IV according to the New York classification.

To determine tactics and select treatment functional assessment heart failure is often carried out according to the New York Heart Association (NYHA) system. This system takes into account symptoms depending on the patient's activity level and quality of life.

New York Heart Association (NYHA) classification of heart failure

Class	Symptoms
I (light)	There are practically no restrictions on physical activity. Ordinary physical activity does not cause shortness of breath, palpitations, or attacks of weakness
II (moderate)	Mild limitation of physical activity. Ordinary physical activity leads to shortness of breath, palpitations, weakness
III (pronounced)	Marked limitation of physical activity. Light physical activity (walking 20-100 m) leads to shortness of breath, palpitations, and weakness
IV (severe)	Inability to perform any activity without symptoms. Symptoms of heart failure at rest. Increased discomfort with any physical activity

Indications

The general indication for heart transplantation is severe decline in cardiac function for which the prognosis for survival at one year is poor.

Specific indications and conditions for heart transplantation

Dilated cardiomyopathy

Ischemic cardiomyopathy

Congenital heart disease with ineffectiveness or lack of effective treatment (conservative or surgical)

Ejection fraction less than 20%

Intractable or malignant arrhythmias when other therapy is ineffective

Pulmonary vascular resistance less than 2 Wood units (calculated as (PAP-CVD)/SV, where PAP is wedge pressure pulmonary artery, mmHg; CVP – central venous pressure, mm Hg; CO – cardiac output, l/min)

Age less than 65 years

Willingness and ability to follow the plan for further treatment and observation

Contraindications

Age over 65 years; This relative contraindication, and patients over 65 years of age are assessed individually
Sustained pulmonary hypertension with pulmonary vascular resistance greater than 4 Wood units
Active systemic infection
Active systemic disease, such as collagenosis
Active malignancy; Patients with a predicted survival of more than 3 or 5 years may be considered candidates; tumor type should also be taken into account
Smoking, alcohol abuse, drug abuse
Psychosocial instability
Reluctance or inability to follow plans for further treatment and diagnostic measures

Survey

Laboratory tests

General clinical examinations are performed: general blood test with counting of formula and platelets, general urine analysis, biochemical analysis blood (enzymes, bilirubin, lipid spectrum, nitrogen metabolism indicators), coagulogram. The test results must be within normal limits. Pathological changes should be clarified and, if possible, corrected.

The blood type, a panel of reactive antibodies are determined, and tissue typing is performed. These tests form the basis of the immunological match between donor and recipient. A cross-test with donor lymphocytes and recipient serum (cross-match) (determination of anti-HLA antibodies) is also performed.

Screening for infectious diseases

Examination for hepatitis B, C. For carriers of the disease and patients with an active process, as a rule, a heart transplant is not indicated (this is a relative contraindication). Hepatitis in recipients is treated differently in different centers around the world; To date, there is no consensus on this issue.

HIV testing

A positive HIV test is considered a contraindication for heart transplantation.

Virological screening

Epstein-Barr virus, cytomegalovirus, virus herpes simplex. Exposure to these viruses in the past (IgG) and the presence/absence of an active process (IgM) are analyzed. A history of infection with these viruses indicates an increased risk of disease reactivation. After heart transplantation, these patients require appropriate prophylactic antiviral treatment.

It should be noted that active infectious diseases should be treated when preparing a patient for heart transplantation (ie, during observation and waitlisting). Patients with a negative test for cytomegalovirus infection, as a rule, cytomegalovirus immunoglobulin (Cytogam) is prescribed. During the observation period before transplantation in America, it is recommended to immunize patients with negative tests for IgG to other viral agents.

Tuberculin skin test

Patients with a positive test require additional evaluation and treatment before being placed on the heart transplant waiting list.

Serological tests for fungal infections

Serological studies on fungal infections also help to anticipate an increased risk of reactivation of the process after surgery.

Screening for cancer

Cancer screening is carried out before inclusion on the waiting list.

Prostate-specific antigen (PSA) test

Prostate-specific antigen (PSA) test. At positive analysis appropriate assessment and treatment is required.

Mammography

Women should have a mammogram. The condition for inclusion on the waiting list is the absence of pathology on the mammogram. In the presence of pathological formations, an oncological examination and, possibly, treatment are necessary before inclusion on the waiting list.

Cervical smear examination

The condition for inclusion on the waiting list is the absence of pathological changes. If pathology is present, an oncological examination and, possibly, treatment are necessary before inclusion on the waiting list.

Instrumental examinations

For cardiopathy, coronary angiography is performed. This study allows you to select patients who can undergo coronary artery bypass grafting (with correction of valve pathology), angioplasty with stenting.

Echocardiography is performed: ejection fraction is determined, cardiac function is monitored in patients on the waiting list for a heart transplant. An ejection fraction of less than 25% indicates a poor prognosis for long-term survival.

To exclude other pathologies of the chest organs, an x-ray of the chest organs is performed, possibly in two projections.

A function test may be used to assess lung function. external respiration. Severe uncorrectable chronic lung disease is a contraindication to heart transplantation.

To assess global cardiac function, maximum oxygen consumption (MVO 2) is determined. This indicator is a good predictor of the severity of heart failure and correlates with survival. An MVO 2 below 15 indicates a poor prognosis for 1-year survival.

Diagnostic invasive procedures

An acute rejection reaction can manifest itself immediately after restoration of blood flow, as well as during the first week after surgery, despite immunosuppressive therapy.

The main problem in modern transplantology are infectious complications. To prevent infections, special organizational and pharmacological measures are taken. In the early postoperative period, they often develop bacterial infections. The incidence of fungal infections increases with the presence of diabetes mellitus or excessive immunosuppression. Prevention of Pneumocystis pneumonia and cytomegalovirus infection is carried out.

The main method for diagnosing a rejection reaction is endomyocardial biopsy. Depending on the severity of the process, it is possible to intensify the immunosuppression regimen, increase the dose of steroid hormones, and use polyclonal or monoclonal antibodies.

The leading cause of death and allograft dysfunction in long term is a pathology of the coronary arteries. In the arteries of the heart, progressive concentric hyperplasia of smooth muscle and intima occurs. The reason for this process is unknown. Cytomegalovirus infection and rejection are thought to play a role in this process. Studies show that with severe initial ischemic and reperfusion injury donor organ and repeated episodes of rejection, the risk of coronary artery damage increases. The treatment for this condition is a repeat heart transplant. In some cases, stenting the affected artery is appropriate.

Outcome and prognosis

According to American estimates, survival after heart transplantation is estimated at 81.8%, 5-year survival rate is 69.8%. Many patients live 10 years or more after transplantation. Functional status recipients are usually good.

Prospects and problems of heart transplantation

The lack and impossibility of long-term storage of donor organs was the impetus for the development alternative techniques treatment of terminal heart failure. Various circulatory support systems (artificial ventricles of the heart) are being created, resynchronization therapy is being carried out, new drugs are being studied, research is being conducted in the field of genetic therapy, and in the use of xenografts. These developments have certainly reduced the need for heart transplants.

An urgent problem remains the prevention and treatment of vascular graft pathology. Solving this problem will further increase the survival rate of patients after heart transplantation.

The issues of selecting recipients and drawing up a waiting list remain problematic from a medical and ethical point of view. We also have to talk about the economic problems of transplantology: the high cost of organizational support for the process, postoperative therapy and patient monitoring.

Heart transplant in Belarus - European quality at a reasonable price

Surgeon Christian Barnard secured eternal glory, having successfully performed something that no one had managed before - a heart transplant. Although his equally famous colleague, Theodor Billroth, said more than a century ago that such a doctor would receive nothing but censure from his colleagues, it turned out that everything happened differently.

Attempts to perform a heart transplant were made back in the 19th century.

There had been many heart transplant attempts before Christian Barnard. First known cases successful operations date back to the end of the 19th century, but there is no direct evidence of a positive outcome.

However, during this period, surgery developed by leaps and bounds, and at the beginning of the twentieth century, the first case of successful expansion of the heart was recorded. And after 15 years, doctors began to actively undertake operations that previously seemed impossible - interventions were carried out to correct abnormalities of the vessels located near the heart.

In the mid-forties, doctors managed to save hundreds of children's lives - scientific advances made it possible to fight birth defects hearts.

By 1953, a device was created that provided the patient with continuous blood circulation. He allowed the American surgeon George Gibbon to perform the first ever corrective operation interatrial septum. This event marked the beginning of a new era in the field of heart surgery.

Carrying out the first successful operation and its outcome

Christian Netling Barnard is a transplantologist. Known for performing the world's first human-to-human heart transplant on December 3, 1967

The first heart transplant in the world took place in South Africa, in the city of Cape Town. On December 3, 1967, at the Grote Schur hospital, 45-year-old surgeon Christian Barnard saved the life of businessman Louis Vashkansky by transplanting the heart of a woman who had recently died in an accident.

Unfortunately, the patient died 19 days later, but the very fact of successful organ transplantation caused a huge resonance in the world of medicine. An autopsy showed that the man died due to double pneumonia, and not due to a medical error. The second attempt was more successful. Philip Bleiberg has lived with someone else's heart for more than a year and a half.

The successful experience of the first transplant in the world inspired other surgeons. Over two years, more than 100 similar operations were carried out.

But by 1970 their numbers had dropped sharply. The reason for this was the high mortality rate several months after the manipulations. It seemed to the doctors that they could give up on transplantations, since the immune system stubbornly rejected the new heart.

The situation changed a decade later. In the early 80s of the 20th century, immunosuppressants were discovered, which solved the problem of survival.

Having received global recognition, Christian Barnard became active scientific work and charity. Dozens of articles on cardiovascular diseases were written by his hand. He himself advocated active image life and proper nutrition. Charitable foundations, which he created and financed mainly independently, help people in all corners of the planet:

Thanks to the money generated by environmentally friendly production clean products and sale of author's literature, famous surgeon financially helped oncology clinics.
Another of his foundations provides financial assistance to poor women and children from countries with low level life.

Modern heart transplants

Valery Ivanovich Shumakov - Soviet and Russian transplantologist, professor

The most famous follower of Christian Barnard in the post-Soviet space was the surgeon Valery Ivanovich Shumakov. And although the operation was carried out 20 years later, it had a huge impact on the entire development of domestic medicine.

But this operation did not become a sensation in the world. Before Shumakov, more than a thousand similar operations were performed and with a more successful outcome. The surgeon’s first patient died a few days later – his kidneys could not withstand taking immunosuppressants.

But Valery Ivanovich did not give up, and after failure with his team he carried out a number of successful transplantations.

Nowadays, scientific advances make it possible to perform thousands of heart transplants every year. About 80% of them end successfully. After transplants, people live from 10 to 30 years. The most common indications for transplantation:

Heart and blood valve defects;
Coronary artery diseases;
Dilated cardiomyopathy.

And most famous case in the history of cardiology was the case history of billionaire Rockefeller. His condition allowed him to do something that is unlikely to be repeated in the coming decades; Rockefeller changed his heart as many as 7 times! The record holder passed away at the age of 101 for reasons unrelated to cardiology.

Since the first heart transplant in the world, a lot has changed. Nowadays transplantations are carried out on such high level that many patients not only live full lives, but also participate in marathon running and are actively involved in sports.

It was the first heart transplant in the world that changed the field of medicine forever. In the 50 years after it, thousands of human lives, both adults and children, were saved.

From this video you will learn about the first heart transplant in the world:

Although there are many indications for transplantation, it is accompanied by the difficulty of selecting a suitable donor who is compatible with the main parameters - blood type, weight and height, absence of tumor or infectious diseases. Therefore, not enough operations are performed, and for patients with severe circulatory decompensation, it is the last hope for saving lives.

Survival after heart transplantation approaches 85 percent, and full recovery of work ability is achieved in half of the patients.

Read in this article

History of transplantation

The very first experience of a human heart transplant from a monkey was carried out by D. Hardy in 1964, the patient lived for a little more than an hour. K. Barnard is considered the founder of heart transplants. In 1967, the heart of a 25-year-old girl who died after a car accident was transplanted to L. Vashkansky. Although the operation itself was very successful, the 55-year-old patient lived for about 2 weeks; his death was associated with severe pneumonia.

Before this, in the 50s, the Soviet scientist Demikhov conducted several successful experiments with lung and heart, head, and liver transplants to dogs, but for political reasons he was not given the opportunity to continue his work.

The first successful transplantation in the Soviet Union was Shumakov's operation in 1987. The patient suffered from dilated myocardiopathy, her life was prolonged, but due to an error in taking the pills, a rejection reaction began, which ended in death. The American Husman had a record life expectancy after transplantation; he lived with a transplanted heart for about 30 years and died of skin cancer.

About 4,000 operations are performed annually in the world; their frequency is comparable to kidney transplantation. Billionaire D. Rockefeller underwent 7 heart transplants during his life, the last one was at the age of 100. In 2009, a heart was transplanted, which was grown from his own stem cells.

When is a heart transplant needed?

Half of all operations are carried out due to last stage, takes up a slightly smaller share, and significantly less often patients with other diseases are saved in this way.

Very strict selection parameters for recipient patients have been developed:

circulatory failure stage 4,
life expectancy is no more than six months,
age gradations - from birth to 60 (sometimes 65 years),
the state of the lungs, liver and kidney functions is normal or there are reversible disorders,
mental stability,
vessels in the lung tissue have normal tone or are treatable,
there are no symptoms of an infectious or oncological disease, thromboembolism,
all other treatment options have been exhausted.

Who does not undergo surgery?

A patient may be excluded from the transplant queue if the following contraindications are found:

lack of desire to undergo long-term rehabilitation and follow all doctors’ recommendations;
irreversible narrowing of the pulmonary vessels;
diabetes mellitus with a tendency to ketoacidosis, identified retinopathy and nephropathy, glycated hemoglobin exceeds 7.5%;
systemic, autoimmune and neurological diseases;
tuberculosis, HIV, syphilis;
kidney failure;
bronchial asthma or obstructive bronchitis with severe respiratory failure;
previous stroke or transient ischemic attack;
disorders of the blood coagulation system that are not compensated by medications;
excess body weight, index over 35 kg/m2;
addiction to drugs or alcohol;
mental illness, social instability;
tumors.

How are donors selected?

A person who may be a heart donor must be determined to be brain dead. At the same time, the work of the heart before transplantation must be supported with drugs and there is an opportunity for rapid transportation to the operating room. The selection criteria are:

age up to 60 years,
same blood type
normal and
the size of the donor heart is within 30 - 50% of the recipient.

Are surgeries performed in Russia, Ukraine, Belarus?

Of all the post-Soviet Slavic states, the situation with transplantology today is best in Belarus. It is there that most operations are performed, this is due to the fact that when brain death is declared, all deceased persons can be recognized as organ donors.

In Russia and Ukraine, the consent of relatives is mandatory for this. Therefore, despite the rather high cost (70 thousand dollars), Belarusian doctors successfully cope with transplants not only for compatriots, but also for foreign citizens.

About 1,000 people in Ukraine and up to 4,000 patients in Russia are waiting in line for a heart transplant. For 16 years, Ukrainian doctors were able to perform very few operations; the reason for this was also the loud scandal surrounding transplant doctors, who were accused of illegal organ transplants. They were justified, but fears among the medical community did not disappear.

There are only eight centers in Russia where heart transplants can be performed, four of which are in Moscow. For comparison, there are 25 of them in Germany, and 130 in America. The waiting time is from 200 to 270 days, so many patients die due to the lack of a suitable donor.

Pre-transplant examinations

In order to ensure that there are no major contraindications for heart transplantation, patients should undergo the following studies:

blood test with a mandatory platelet and leukocyte count;
coagulogram;
urine test;
biochemical parameters of bilirubin, enzymatic activity and lipid spectrum, content of sugar and nitrogenous bases;
blood group, immunological studies;
cross-test for compatibility of donor and recipient tissues;
analysis for hepatitis, HIV, herpes virus, cytomegalovirus infection, tuberculosis, fungal diseases;
tumor markers;
mammography in women and a gynecologist’s report;
examination by a urologist for men;
coronary angiography;
EchoCG - with an ejection fraction below 25 - 27%, the prognosis for survival is pessimistic;
chest x-ray;
Ultrasound of the kidneys and liver, cerebral vessels.

The data from all studies must be within the limits of physiological parameters, or stable compensation of disorders must be achieved before surgery.

How is a heart transplant performed?

First, an incision is made in the chest along the middle of the sternum and patients are connected to a heart-lung machine through the vena cava. In the future, the operation process may have different stages depending on the selected option.

If the donor's heart is installed in the place where the patient's heart was, then this method is called orthotopic and can be performed by suturing the right atrium of the donor to the right atrium of the patient's own heart.

Heterotopic transplantation involves placing a new heart next to the old one. A connection is created between the following paired zones:

left atria of both hearts,
both aortas,
superior vena cava,
pulmonary arteries.

The latter technique is preferable for patients with signs pulmonary hypertension, disproportionality of hearts.

Recovery after

The most difficult stage after surgery is the first weeks, as the body must adapt to new blood circulation conditions and foreign antigens. Most often, the success of treatment depends on the progression of right ventricular failure. Almost all patients experience arrhythmias and weakness sinus node. Combined left- and right-ventricular hemodynamic decompensation is also considered an unfavorable sign.

If the donor heart was injured, it was noted metabolic disorders, a long period of hypoxia, then large doses of cardiotonic drugs are required. The prognosis in such cases is often unfavorable.

Restoration of heart function begins only by day 3. After cardiac output has stabilized, the patient is transferred from the intensive care unit to a regular ward, and most medications are allowed to be taken in tablet form.

Features clinical manifestations transplanted heart are:

no pain even with severe ischemia;
high heart rate at rest, it does not change during the phases of the respiratory cycle or changes in body position;
paradoxical reaction to medications;
There are 2 P waves on the ECG.

Cyclosporine after heart transplantation

Most patients are shown a triple regimen of cytostatics and hormones using Cyclosporine, Methylprednisolone and Azathioprine. With a significant decrease in immunity, bacterial infections occur, which requires the inclusion of antibiotics in the regimen.

The most serious complication is graft rejection. It can begin at different times, so patients must be constantly under the supervision of doctors after discharge from the hospital, undergo full examination including biopsy.

How to live for a child with a new heart

If a heart transplant is performed on an infant, then the basic rule for good recovery– this is a calm environment, the child should not cry too much or overexert himself when feeding. It is important to protect it from contact with strangers in order to minimize the risk of infection.

Walking on the fresh air And good nutrition. Visits to a cardiologist are recommended at least once a month after discharge, and then their frequency may be less. Children school age usually have difficulty withstanding restrictions on movement patterns and communication with peers. But in order to expand the activity regimen, you need to get permission from your doctor.

Gradually, as the heart function is restored, physical activity is increased in the form of physical therapy.

The available results of successful operations prove that when proper treatment and following the recommendations, a transplanted heart is not an obstacle to normal life and even sports.

How long do you live after surgery?

According to the accumulated data on heart transplantation in all world clinics, the annual survival rate after surgery is 85%, and sometimes it is even higher. Most often, the prognosis for life is determined by the first weeks and months. In the future, the danger comes from treatment with cytostatics (decreased immunity, effect on the liver), heart rejection and the development of coronary angiopathy.

A ten-year life expectancy with a transplanted heart was observed in half of the patients. It is lower with the following risk factors:

old age of the donor and/or recipient;
the donor heart was in a state of ischemia for a long time;
high levels of bilirubin and creatine phosphate in the patient;
an infectious disease that occurred before the transplant or 1 year after it;
disturbance of cerebral blood flow;
diabetes mellitus, especially type 1.

Approximately half of patients are able to return to labor activity, cases of fairly high life expectancy have been noted. More than 20 thousand people with donor hearts live in the United States; their basic vital parameters are not very different from healthy people.

Heart transplant is the only chance for life for patients with end-stage heart failure due to myocardial ischemia or decompensated cardiomyopathy. There are strict criteria for selecting donors and recipients. The problem is complicated in countries where the donor can only be a close relative, and in order to obtain permission to transplant the organs of a deceased person, written consent from relatives is required.

After successful operation It is necessary to take medications for a long time, follow recommendations for nutrition and physical activity, and undergo regular examinations. The most severe complication is donor heart rejection.

Who performed the world's first heart transplant?

The world's first successful heart transplant was performed in 1962 on the territory of the USSR by the honored experimental scientist Vladimir Demikhov. The surgeon performed surgery on the animal, successfully transplanting lungs and a heart into the dog.

The first human heart transplant took place in 1964. The operation was performed by James Hardy. An animal, a chimpanzee, acted as a donor then. The recipient's vital activity lasted 1.5 hours.

The first person-to-person heart transplant was performed in 1967 in South Africa - Dr. Christian Bernard transplanted a heart to a man who died as a result of a car accident. A 55-year-old patient died 18 days after surgery.

IN Soviet era human heart transplant performed in 1987. The surgical intervention was carried out under the guidance of surgeon Valery Shumakov. The recipient was Alexandra Shalkova, who was diagnosed with dilated cardiomyopathy, which threatened with imminent death.

The transplant extended the patient's life by 8.5 years.

The operation became possible thanks to the introduction of the diagnosis of “brain death”, in which the work of the heart, breathing and blood circulation are artificially supported. It appears that the patient is alive.

How much is a person's heart worth?

A heart transplant is one of the most expensive operations in the world. The price varies depending on the location of the clinic and its prestige in the world rankings, and the number of diagnostic procedures performed.

The cost of transplantation for each case is determined individually. On average, an operation of this kind costs 250-370 thousand dollars.

Sale human organs prohibited and punishable by law in the world. Therefore, a heart can only be transplanted from deceased relatives, or donors, with written permission.

The patient receives the organ itself free of charge, but material costs requires directly surgery, medication course, as well as the rehabilitation period.

The cost of a heart transplant in the Russian Federation ranges from $70 thousand to $500 thousand dollars. The country has a quota program for patients who need high-tech operations.

The more accurate cost of transplantation and the chances of it being performed free of charge are clarified individually - during a consultation with a transplantologist.

There is only one coordination center on the territory of the Russian Federation that is engaged in the selection of donors. It covers the territory of Moscow and the region.

Operations are directly carried out in Novosibirsk (NIIPK named after E. N. Meshalkin), St. Petersburg (FSBI "North-West Federal Medical Research Center named after V. A. Almazov") and in the capital (FSBI "FSTIIO named after V. I. Shumakov").

The principles of organ donation in Russia are not yet sufficiently developed at the official level, which becomes an obstacle to heart transplantation.

Thus, on average, about 200 transplants are performed per year throughout the country, while in the United States there are more than 28 thousand. Therefore, most people with incurable heart disease require expensive surgery abroad.

Who needs a transplant?

Heart transplantation is indicated for persons suffering from pathology that does not give a chance of life expectancy of more than one year when used conservative methods treatment.

Malignant arrhythmia;
Heart failure;
Cardiomyopathies;
Inoperable heart pathologies;
Angina pectoris, severe heart rhythm disturbances.

The patient's age should not exceed 65 years.

Contraindications

The main contraindications for heart transplantation are:

The presence of diabetes mellitus at a severe stage with persistent damage to the kidneys, retina and blood vessels.
Pulmonary hypertension.
Tuberculosis, HIV.
Liver and kidney failure.
Drug or alcohol addiction.
Oncology.
Exacerbation of mental illness.
The patient's age is 65 years and above.

Heart transplant for children

The positive experience of heart transplants in adults stimulated the transplantation of a vital organ to children. To perform this operation, it is necessary to record brain death in the donor.

In world practice, the probability fatal outcome in children under five years of age after transplantation it is 24%. Reason this phenomenon are postoperative complications.

At this time in Russia the heart seems to be the only body, which is not transplanted into children under 10 years of age. It's all because of the absence legislative framework for organ removal from minor donors.

Despite the fact that transplantation is possible with the permission of the parents of a deceased child, such operations have not yet been practiced in the Russian Federation.

How to become a donor?

Patients often spend more than one year waiting for a heart transplant, which negatively affects their condition. As a result, many die without waiting for a life-saving transplant.

Heart donors become only after death. The body parameters of the deceased must meet several criteria.

Namely:

Age up to 45 years;
Healthy cardiovascular system;
Negative test result for HIV and hepatitis B and C;
Brain death.

Most donors are victims of accidents or those killed at work. According to current Russian legislation, the presumption of consent to the removal of internal organs is widespread in the Russian Federation.

So, if a person has not refused posthumous donation while still alive, after death his organs can be used for transplantation. But if the relatives of the deceased refuse of this event, transplantation becomes illegal.

Sometimes an “artificial heart” is used to save the patient’s life. It was created by the combined efforts of engineers and cardiac surgeons.

These devices are divided into:

Hemooxygenators, which support blood circulation during open-heart surgery.
Cardiac prostheses– used as a replacement for heart muscle. Allows you to ensure human life at a high-quality level.

Devices of this type are widely used for temporary provision of blood circulation, since at the moment the donor heart is less functional than the artificial counterpart.

How is the operation performed?

The transplant begins with the removal of the donor heart from the body. At the same time, the patient is being prepared, who is administered analgesics and sedatives. At this time, the heart is in a special solution.

Surgeons cut off the ventricles from the heart while maintaining the activity of the atria, which set the rhythm of the organ's contraction. After connecting to the donor atria, a temporary pacemaker is fixed (about the types of devices).

The donor organ is located in two ways:

Heterotopic– provides for the preservation of the patient’s heart. The implant is located nearby. Possible complications– compression of organs, formation of blood clots.
Orthotopic – sick heart completely replaced by the donor.

The implant automatically starts working after it is connected to the bloodstream, but sometimes it is started using an electric shock.

The average duration of the operation is about six hours. After it is carried out, the patient is placed in the department intensive care, where his condition is supported by a pacemaker and an artificial respiration apparatus.

Data on cardiac activity is currently displayed on the cardiac monitor. Fluid is drained from the chest using drainage tubes.

After surgery, strict bed rest, and only after a few months you can perform light exercises.

Postoperative complications

Heart transplantation is one of the most complex operations. Surgery can lead to complications, such as rehabilitation period, and at later stages.

At the initial stage	During the year	After 5-7 years
Allergic reactions, donor heart rejection	Infectious infestations	Arterial dysfunction, atherosclerosis
Opening of bleeding	Vascular pathology (vasculopathy)	Ischemia
Fluid accumulation in the pericardium	Malignant formations	Heart failure
Immune suppression leading to viral, fungal and bacterial infections	Implant rejection processes	Valve dysfunction

Thus, after the operation, the patient may experience bleeding at the incision site. During this period, the recipient becomes vulnerable to viral, fungal and bacterial infections.

These processes are prevented by taking antibiotics. It is also possible that the process of rejection of the implanted organ and the occurrence of myocardial ischemia may develop.

Symptoms indicating the need for emergency contact with specialists in the field of heart transplantation:

Constant shortness of breath;
Arrhythmia;
Discomfort and chest pain;
High temperature, chills;
Indigestion;
Swelling, fluid retention in tissues;
Increasing cough;
Bloody discharge;
Problems with coordination and balance;
Headache;
Changes in blood pressure.

The above manifestations and the slightest deterioration in the patient’s well-being are grounds for hospitalization. Timely diagnosis will allow you to eliminate the pathology without serious complications.

Prevention after heart transplant

Following some rules will help to increase the overall life expectancy after a heart transplant and improve its quality:

Accept special drugs. The dosage and time of administration should be observed. Most drugs are cytostatics and hormonal drugs aimed at suppressing the immune system.
Avoid physical activity.
Follow your diet. Drinking alcohol, smoking and eating fatty foods is strictly prohibited. It is worth following a gentle diet.
Avoid temperature changes and taking hot baths.
Avoid infections as much as possible. Do not visit places with large crowds of people, carefully monitor personal hygiene, drink boiled water, and eat processed foods.

Despite a number of limitations, the life of a recipient after a heart transplant changes for the better. Following the series simple rules, you can forget about shortness of breath, rapid heartbeat and tissue swelling.

Forecast Statistics of deaths and pathologies during heart transplantation

Timely transplantation makes it possible to prolong life while maintaining moderate physical activity and ability to work.

The heart is rightly considered the most important vital organ. After all, it is what ensures blood circulation, which delivers oxygen and nutrients to organs and tissues and removes carbon dioxide and decay products from them. Stopping the heart means stopping the blood supply to the body and, accordingly, its death. A heart transplant is an operation in which a weak, diseased heart is replaced with a healthier, donor heart.

A heart transplant is a treatment that is usually reserved for people who have tried medications or other surgeries but their condition has not improved enough. Heart transplantation ICD-10 code: Z94.1 Presence of a transplanted heart.

Heart transplant surgery

Unfortunately, irreversible events can occur in the heart. pathological changes, leading to serious violations its functions. Such pathologies can be either congenital or acquired under the influence of unfavorable factors, such as previous diseases, the effect of certain chemicals, etc. Sometimes pathological changes in the heart are so severe that they cannot be corrected either by therapeutic or traditional surgical methods.

IN old times a patient with such disorders was doomed. But today there is a radical opportunity to save even such patients. Thanks to advances in the field of medicine such as transplantology, in particularly severe cases a heart replacement can be performed. Doctors replace a diseased organ with a healthy one taken from a donor, just like replacing a worn-out part in a car.

What is such an operation, and in what cases is it needed?

First heart transplant: history

Long before person-to-person transplantation was ever introduced to the public, scientists were conducting groundbreaking medical and surgical research that would ultimately lead to today's advances in transplantation. From the late 1700s to the early 1900s, the field of immunology slowly developed through the work of numerous independent scientists. Notable breakthroughs included Ehrlich's discovery of antibodies and antigens, Lansteiner's blood typing, and Metchnikoff's theory of host resistance.

Due to advances in suture techniques in the late 19th century, surgeons began performing organ transplants in their laboratory research. There were enough experiments done in the early 20th century to know that (cross species) invariably failed, allogeneic grafts (between individuals of the same species) usually failed, while autografts (within the same human, usually skin grafts) have almost always been successful. There was also an understanding expressed that repeat transplants between the same donor and recipient are subject to accelerated rejection and that graft success is more likely when the donor and recipient share a common “blood relationship.”

Information appeared in the domestic media that, however, this is not true.

The first human heart transplant from a chimpanzee

First clinical transplantation heart surgery was performed at the University of Mississippi Hospital on January 23, 1964 by Dr. James Hardy. This orthotopic transplantation was preceded by extensive animal studies, and the clinical operation fully supported the value of the techniques previously used in the laboratory.

The recipient was a 68-year-old white man, Boyd Rush, in terminal shock from extremely severe atherosclerotic coronary artery disease.

The intended recipient went into terminal shock at approximately 6:00 p.m., with a blood pressure of 70 and virtually no breathing except for continued use of mechanical ventilation through a tracheotomy tube. Death was clearly imminent, and it was obvious that if a heart transplant was to be performed, it had to be done immediately. - Hardy later recalled in his memoirs.

Hours later, Hardy and his team made history by performing the first heart transplant. The chimpanzee's heart beat for 90 minutes in Rush's chest, but unfortunately was too small to keep his new human body alive. Hardy's patient died shortly after completion of the operation.

At the time of transplantation, the donor heart was well preserved and easily defibrillated. Strong quality myocardial contractions were recorded via video, and the graft functioned for almost two hours after defibrillation. The progressive state of preoperative metabolic deterioration in the recipient and the size of the donor organ contributed to both the eventual decompensation of the transplanted heart. This one is the first clinical experience clearly defined the scientific feasibility of human heart transplantation.

Hardy's decision to use a chimpanzee's heart came under immediate attack from both the public and the medical community. The operation caused intense ethical, moral, social, religious, financial, governmental and even legal problems.

Over the next few months, some of the criticism in the medical community subsided after Hardy published an article in the Journal of the American Medical Association in which he described strict ethical principles, which he and his team followed when assessing both donor and recipient.

Even after the first successful human-to-human heart transplant, surgeons continued to experiment with animal hearts. Between 1964 and 1977, hearts from sheep, baboons and chimpanzees were transplanted into at least four adults, all of whom died within days of surgery.

First human-to-human heart transplant

On the afternoon of Saturday, December 2, 1967, a tragedy occurred that was to set in motion a chain of events that would make world history.

The family, having gone to visit friends that day and not wanting to arrive empty-handed, stopped opposite a bakery on the main Cape Town Observatory Road. The man and his son waited in the car while his wife and daughter went to the store to buy a cake. A few minutes later they appeared, began to cross the road, and both were hit by a passing car. The mother was killed instantly and the daughter was taken to Groote Schuur Hospital in critical condition and later declared brain dead. This young lady, aged 25, was Miss Denise Darvall.

Only those who have lived through a similar catastrophe can feel what Denise Darvall's father experienced. Faced with the loss of his wife and daughter, Mr. Edward Darwall had the courage and love of his fellow men to agree to the donation of his daughter's heart and kidneys. A human heart transplant without Edward Darwall's permission would be impossible!

The second family in Cape Town was to become inextricably linked to the Darwall tragedy. At the end of 1967, one of the patients seen by specialists cardiology department Groote Schuur Hospital, was a 53-year-old doctor from Sea Point. He suffered a series of heart attacks that almost completely disabled his heart muscle. His body was bloated, he could barely breathe, and he was close to death. Doctors and his family, however, recognized the fantastic spirit and courage with which he fought to save his life. His name was Louis Washkansky.

The cardiology department was responsible for the majority of donor patients surgical department cardiothoracic surgery at Groote Schuur Hospital. The late Professor Velva Srire, who led this group of specialists, had the foresight and courage to recognize that the surgical methods used at that time could not help all forms of severe heart failure. The meeting of this indomitable patient and the visionary professor of cardiology was another link in the chain of events that were to make history. Dr. Louis Washkansky was ready and brave enough to take a chance on the unexplored surgical treatment, the world's first human heart transplant.

December 3, 1967
Christiaan Barnard, a South African heart surgeon, speaks with Louis Washkansky after performing the world's first successful human-to-human heart transplant. The heart transplant scar is covered with a bandage.

The head of the Department of Cardiothoracic Surgery at Groote Schuur Hospital at that time was Professor Christian Barnard. He grew up and spent his childhood in the Karoo region, and became a highly skilled and dedicated surgeon and, ultimately, one of the most famous cardiac surgeons of our time. By 1967, he had assembled a team of talented surgeons to assist him. However, in addition to the remarkable surgical abilities of Professor Barnard and his team, the skills of many other disciplines were required. These include:

cardiologists who assisted in diagnostic assessment patient and confirmed that the revolutionary surgical procedure is the only one possible form treatment;
the radiologists and radiologists who provided the x-rays;
pathologists and their technologists who processed laboratory tests;
immunologists who have determined that the donor heart will not be rejected by the patient;
anesthesiologists who provided a safe anesthetic and monitored all vital functions;
experienced nurses in the intensive care unit and ward who assisted doctors and provided qualified medical care at every stage;
technologists who operated the lung treatment machine and other equipment;
a blood transfusion service that ensured the availability of sufficient and safe blood.

Besides these people, there were others who supported the project in the background in different ways. All the individual links in the historical chain were forged, and shortly after midnight that Saturday the operation began. At 6 a.m. on Sunday, December 3, 1967, the new heart in Dr. Louis Washkansky was electrically shocked into action.

The world's first successful human heart transplant took place at Groote Schuur Hospital.

This event attracted international attention to Groote Schuur Hospital and created worldwide awareness of the experience and capabilities of its staff. Professor Barnard undoubtedly had the appropriate training, research experience and the necessary surgical skills to perform this remarkable feat. He also had the vision and courage to accept the medical, ethical and legal risks associated with performing the world's first human heart transplant. However, it must be remembered that this transplant could never have happened without the skills and support of many other disciplines.

First heart transplant in the USSR

First heart transplant in the USSR was carried out on November 4, 1968 by a group of surgeons led by Alexander Alexandrovich Vishnevsky. However, information about this operation was classified and not disclosed; it is assumed that the heart transplant was unsuccessful.

A lot of bureaucratic barriers stood in the way of carrying out such an operation in the USSR in subsequent years. The key factor was that brain death was not considered a reason for removing donor organs from a person and transplantation in this case was not permitted. The legislation of that time allowed the removal of organs (kidneys, liver, heart) only from donors with a beating heart. These laws contained complete absence logic and a sound heart. Valery Shumakov was a pioneering cardiac surgeon who managed to overcome bureaucratic barriers and perform the first successful heart transplant in the USSR on March 12, 1987. The patient was 27-year-old Alexandra Shalkova.

Who was the first to perform a heart transplant?

Many attempts have been made around the world about heart transplantation, but we will give examples of only the most famous operations that caused a resonance in the public and contributed to the development of the transplantation industry.

Doctor	Venue	Patient	Date	Donor	Result
James Hardy	Oxford, Mississippi, USA	Boyd Rush	January 23, 1964	Chimpanzee	The recipient died after 90 minutes
Christian Barnard	Cape Town, South Africa	Louis Washkansky	December 3, 1967	Died 18 days later from pneumonia
A. A. Vishnevsky	Military Medical Academy, Leningrad, USSR	unknown	November 4, 1968	unknown	Supposedly the operation was unsuccessful.
V. I. Shumakov	National Medical Research Center for Transplantation and artificial organs named after V.I. Shumakov	March 12, 1987	March 12, 1987	Alexandra Shalkova	Successful operation. The patient died 10 years later.

When is a heart transplant required?

Today, heart transplant surgery is no longer perceived by people as something fantastic. This procedure has become firmly established medical practice in many countries of the world, including Russia. Despite the complexity of its implementation, cardiac transplantation is a very popular operation, since the number of hearts for which a transplant is the best, and sometimes even the only way to save life and restore health is quite large.

We can safely say that the history of heart transplantation began in 1967, when South African doctor Christian Bernard transplanted an organ into an elderly terminally ill patient, Louis Washkansky. Despite the success of the operation itself, Louis did not live long and died eighteen days later due to double pneumonia.

Thanks to the improvement of transplantation techniques and the use of drugs that reduce the risk of immune rejection of a transplanted heart, today the life expectancy of patients after surgery exceeds ten years. The patient who lived the longest with a heart transplant was Tony Huseman. He passed away due to skin cancer thirty years after the transplant.

Indications for surgery

The main indication for transplantation is cardiac pathologies at a severe stage, during which treatment with other means is ineffective.

The prerequisite for transplantation is normal operation others important organs for human life and hope for full recovery. Therefore, contraindications to transplantation are irreversible renal or liver failure, as well as serious illnesses lungs.

When is a heart replacement indicated?

The main indication for heart transplantation is heart failure.

This pathology is a dysfunction of the myocardium. There are 3 degrees of this disease. In the first degree, shortness of breath with rapid pulse is observed with severe physical activity and some decrease in working capacity. The second degree is characterized by shortness of breath and palpitations even with light exertion. In the third degree, shortness of breath occurs even at rest. In addition, due to insufficient blood supply, pathological changes develop in other organs - lungs, liver, kidneys, etc.

Heart transplantation is prescribed for patients with third degree heart failure. The progressive development of this disease, leading to the need for a transplant, can be caused by such reasons as

Impaired ability of the heart to contract due to enlargement of one or both ventricles.
Severe ischemia accompanied by severe atrophy of the heart muscle.
Congenital heart defects that cannot be corrected by cardiac surgery.
Benign tumors in the heart.
Dangerous incurable forms of arrhythmia.

When is heart transplant contraindicated?

Heart transplantation has its limitations. This operation should not be performed in cases where it is inappropriate or there is a risk negative consequences too great and therefore unjustified. The main contraindications to heart replacement are various pathologies, which include:

Sustained pulmonary artery hypertension.
Infectious lesions of the body that are systemic in nature.
Systemic pathologies of connective tissue.
Autoimmune diseases.
Mental disorders and other factors that complicate communication between doctor and patient.
Oncological diseases with a malignant course.
Advanced severe diseases of internal organs.
Diabetes mellitus without treatment.
Aggravated peptic ulcers stomach and duodenum.
Viral hepatitis in active form.
Excessive drinking, smoking, drug addiction.
Overweight.

If there are diseases that are contraindications for transplantation, appropriate treatment is prescribed, if possible. Only after achieving remission of the disease can the patient be allowed to undergo cardiac transplantation.

There are also age restrictions for transplantation. The age threshold for a heart transplant is sixty-five years. However, in some cases, the operation can be performed on older patients. The decision on the admissibility of a transplant is made by the doctor, based on the health status of the individual patient.

Heart replacement is not performed if the patient refuses the operation or is not ready to comply with medical instructions during the rehabilitation period.

How to do a heart transplant

The heart replacement procedure includes two stages:

Preparation for surgery.
The transplant operation itself.

The preparatory stage consists of thorough examination patient's body for timely detection contraindications for transplantation.

What does preparation for cardiac transplantation include?

During preparation for a heart transplant, the following diagnostic procedures are performed:

Determination of blood parameters (group, Rh factor, coagulability).
Blood test for the presence of hepatitis and immunodeficiency viruses.
Screening for cancer, consisting of a mammogram and smear and cervical sampling for women, and a prostate specific antigen blood test for men.
Examination for infection with herpes viruses.

Herpes viruses, such as cytomegalovirus, herpes virus and Epstein-Barr virus, can be activated during artificial immune suppression required after transplantation and cause dangerous diseases - up to general defeat body.

In addition to examining the general condition of the body, the heart and surrounding areas are examined. blood vessels. If necessary, bypass surgery or stenting is performed. In addition, the patient must have his lungs checked using X-rays, as well as his external respiratory function.

The preparatory stage also includes medical procedures aimed at relieving existing heart diseases. Therapy includes the use of beta blockers, cardiac glycosides, diuretics, etc.

An extremely important part of preparing for surgery is immunological study tissues according to the HLA system. Based on the results of this testing, a suitable donor heart will be selected.

Heart replacement surgery

A person under the age of sixty-five whose life was tragically cut short as a result of an accident, such as a car accident, can become a heart donor for a transplant. The main problem during transplantation is the timely delivery of a donor organ, since the maximum viability of a heart removed from a corpse is six hours from the moment of death. It is advisable to transplant the heart when no more than three hours have passed since it stopped, since tissue ischemia may begin later.

Ideally, a heart for transplantation should be free of ischemia and other pathologies. However, if an urgent transplant is necessary, an organ with minor deviations from the norm can be used.

In addition to tissue compatibility, the criterion for choosing a donor organ is also its compliance chest recipient by size. If the heart is too large, it will not be able to function fully in confined spaces.

How is a heart transplant performed?

A heart transplant is a long operation, requiring at least ten hours to complete. Surgical intervention is performed under general anesthesia. The most important task during transplantation is to provide artificial blood circulation.

The procedure is preceded by a repeated blood test for coagulation and glucose levels, as well as measurement blood pressure. This will allow you to determine the most optimal mode carrying out the operation.

Heart replacement involves the following steps:

disinfection of the operation area;
longitudinal cutting of tissue above the sternum;
opening the chest;
removal of the ventricles of the heart while preserving the atria and the vessels adjacent to them;
attachment of the donor organ to the atria and vessels;
suturing fabric.

There are heterotopic and orthotopic heart transplantation. In the first case, the patient does not have his own heart removed, but the donor organ is placed underneath it on the right. This method is labor intensive to perform and results in compression of the lungs by two hearts, but is more suitable for patients with high blood pressure in the pulmonary circulation.

In an orthotopic transplant, the patient's heart is removed and a donor organ is sutured in its place.

After a heart replacement, the patient is prescribed therapy to prevent rejection of the transplanted organ and consists of the use of cytostatic and hormonal drugs.

Rehabilitation period after heart replacement

After surgery, the patient must undergo a myocardial biopsy. In the first month after transplantation, the frequency of this procedure is once every 7-14 days. In the future, biopsies are performed less frequently.

In the early postoperative period, constant monitoring of the hydrodynamics and general condition of the patient’s body is required. To heal the wound left after surgical intervention, it takes 1-1.5 months.

After heart transplant surgery, the greatest danger is the following complications:

Rejection of the transplant, which can occur either immediately after transplantation or after several months.
Opening of bleeding.

If there is bleeding, repeat surgery is required to correct the problem.

Complications due to infection in the wound are also possible. To prevent them, the patient is prescribed antibacterial drugs.

Currently, more than 85% of patients survive the first year after transplantation. About half of patients live longer than ten years after transplantation.

Normally, the duration of uninterrupted operation of the transplant is from 5 to 7 years. Subsequently, aging and atrophy processes begin in the organ, which proceed much more intensely than in a healthy heart. As a result, donor organ failure gradually develops. For this reason, the life expectancy of people with a transplant is less than the statistical average.

How long do you live after a heart transplant?

Today, heart transplantation is the only effective treatment for people with serious ischemic heart disease. One-year life expectancy after a heart transplant is about 85%, five-year life expectancy is 65%.

Lifespan

Life after heart transplant depends on several factors:

general reaction of the body;
state immune system patient;
age.

Despite advances in medicine, the likelihood side effects is saved. Taking into account development various pathologies depends on how long you live after a heart transplant and the ability to improve your quality of life.

Complications at an early stage

Most often, the new organ is rejected. To prolong life after a heart transplant, patients are required to take medications that inhibit the synthesis of T-lymphocytes. Moreover, the use of these drugs is lifelong.

Clinical symptoms of rejection may vary. First signs:

weakness;
elevated temperature;
dyspnea;
migraines.

Treatment of rejection consists of administering increased dosages of glucocorticosteroids, performing plasmaphoresis and other measures aimed at removing toxic substances.

Another complication is infectious diseases, which are the result of a decrease in human immunity.

Late stage complications

After several years, the likelihood of infections and rejection decreases significantly. But a person faces other complications, the most common being a decrease in the lumen of the capillaries. This is the main reason fatal outcome in the later stages after transplantation.

The problem of capillary narrowing can only be determined when all complications can be overcome in the early stages. Today, doctors are successfully coping with this pathology. Saving a life after replacing a person’s heart is possible only if the narrowing of the arteries is diagnosed in a timely manner.

Today, heart transplantation is the method of choice for many patients with cardiovascular diseases. The number of people who have already had this operation increases every year. Despite the fact that transplantation carries many complications, this operation is in great demand.

How much does a heart transplant cost?

Heart transplantation is a very expensive operation, as it requires highly qualified doctors and the availability of modern, expensive equipment. In Russia, a heart replacement costs about 100 thousand dollars, and in Western European countries and the USA - from 300 to 500 thousand dollars. The price in Western countries is much higher, but this price includes all postoperative care.

However, the patient has the option of a free heart replacement. To do this, the patient must be on a waiting list for a heart transplant. However, due to the shortage of organs for transplantation, free operations are very rare and many people in need of a transplant do not wait for their turn.