1 heart transplant. A chance for a long and happy life - heart transplant: features of the operation and the life of patients

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All recommendations are indicative in nature and are not applicable without consulting a doctor.

Modern medicine has stepped so far forward that today an organ transplant can no longer surprise anyone. This is the most effective and, sometimes, the only possible way save a person's life. Heart transplantation is one of the most complex procedures, but at the same time, it is extremely in demand. Thousands of patients wait for “their” donor organ for months and even years, many do not wait, and for some a transplanted heart gives a new life.

Attempts to transplant organs were made back in the middle of the last century, but insufficient equipment, ignorance of some immunological aspects, lack of effective immunosuppressive therapy The operation was not always successful, the organs did not take root, and the recipients died.

The first heart transplant was performed half a century ago, in 1967, by Christian Barnard. It turned out to be successful and new stage in transplantology began in 1983 with the introduction of cyclosporine into practice. This drug made it possible to increase the survival rate of the organ and the survival rate of recipients. Transplantations began to be carried out all over the world, including in Russia.

The most important problem modern transplantology there is a shortage of donor organs, often not because they are physically absent, but due to imperfect legislative mechanisms and insufficient awareness of the population about the role of organ transplantation.

It happens that relatives healthy person, who died, for example, from injuries, is categorically against giving consent to the collection of organs for transplantation to patients in need, even being informed of the possibility of saving several lives at once. In Europe and the USA, these issues are practically not discussed, people voluntarily give such consent during their lifetime, and in the countries of the post-Soviet space, specialists still have to overcome a serious obstacle in the form of ignorance and reluctance of people to participate in such programs.

Indications and obstacles to surgery

The main reason for transplantation donor heart a person is considered severe heart failure, starting from the third stage. Such patients are significantly limited in their life activities, and even walking is difficult. short distances causes severe shortness of breath, weakness, tachycardia. In the fourth stage, signs of a lack of cardiac function are present even at rest, which does not allow the patient to show any activity. Usually at these stages the survival prognosis is no more than a year, so the only way help - transplant a donor organ.

Among the diseases that lead to heart failure and can become testimony for heart transplantation, indicate:

When determining the indications, the patient's age is taken into account - he should be no more than 65 years old, although this issue is decided individually, and under certain conditions, transplantation is carried out for older people.

Others no less important factor consider the willingness and ability on the part of the recipient to follow the treatment plan after organ transplantation. In other words, if the patient obviously does not want to undergo a transplant or refuses to undergo necessary procedures, including in the postoperative period, then the transplantation itself becomes impractical, and the donor heart can be transplanted to another person in need.

In addition to the indications, a range of conditions incompatible with heart transplantation has been defined:

Age over 65 years (relative factor, taken into account individually);
Sustained increase in pressure in pulmonary artery over 4 units Wood;
System infectious process, sepsis;
Systemic diseases connective tissue, autoimmune processes (lupus, scleroderma, ankylosing spondylitis, active rheumatism);
Mental illness and social instability that prevent contact, observation and interaction with the patient at all stages of transplantation;
Malignant tumors;
Severe decompensated pathology of internal organs;
Smoking, alcohol abuse, drug addiction (absolute contraindications);
Severe obesity can become a serious obstacle and even an absolute contraindication to heart transplantation;
The patient's reluctance to undergo surgery and follow the further treatment plan.

Patients suffering from chronic concomitant diseases, should be subjected to maximum examination and treatment, then the obstacles to transplantation may become relative. Such conditions include diabetes mellitus, correctable with insulin, stomach and duodenal ulcers, which through drug therapy can be put into remission, inactive viral hepatitis and some others.

Preparation for donor heart transplantation

Preparation for the planned transplant includes wide range diagnostic procedures, ranging from routine examination methods to high-tech interventions.

The recipient must:

General clinical examinations of blood, urine, coagulation test; determination of blood group and Rh status;
Tests for viral hepatitis ( acute phase– contraindication), HIV (infection with the immunodeficiency virus makes surgery impossible);
Virological examination (cytomegalovirus, herpes, Epstein-Barr) - even in an inactive form, viruses can cause an infectious process after transplantation due to immunosuppression, therefore their detection is a reason for preliminary treatment and prevention of such complications;
Screening for cancer - mammography and cervical smear for women, PSA for men.

Besides laboratory tests, is carried out instrumental examination: coronary angiography, which makes it possible to clarify the condition of the heart vessels, after which some patients can be referred for stenting or bypass surgery, Ultrasound of the heart, necessary to determine functionality myocardium, ejection fraction. Shown to everyone without exception X-ray examination lungs, external respiration functions.

Among the invasive examinations used catheterization of the right half heart, when it is possible to determine the pressure in the vessels of the pulmonary circulation. If this indicator exceeds 4 units. Wood, then the operation is impossible due to irreversible changes in the pulmonary bloodstream, at a pressure in the range of 2-4 units. there is a high risk of complications, but transplantation can be performed.

The most important stage of examining a potential recipient is immunological typing according to the system HLA, based on the results of which a suitable donor organ will be selected. Immediately before the transplant, a cross-match test with the donor's lymphocytes is performed to determine the degree of suitability of both participants for organ transplantation.

During the entire waiting period for a suitable heart and the preparation period before the planned intervention, the recipient needs treatment for the existing cardiac pathology. For chronic heart failure, a standard regimen is prescribed, including beta blockers, calcium antagonists, diuretics, ACE inhibitors, cardiac glycosides, etc.

If the patient’s well-being worsens, the patient may be hospitalized at an organ and tissue transplantation center or a cardiac surgery hospital, where a special device can be installed that allows blood to flow through bypass routes. In some cases, the patient may be moved up the waiting list.

Who are the donors?

A heart transplant from a living healthy person is impossible, because taking this organ would be tantamount to murder, even if the potential donor himself wants to give it to someone. The source of hearts for transplantation is usually people who died from injuries, road accidents, or victims of brain death. An obstacle to a transplant may be the distance that the donor heart will need to travel on the way to the recipient - the organ remains viable for no more than 6 hours, and the shorter this interval, the more likely the success of the transplantation.

An ideal donor heart would be an organ that is not affected by coronary disease, whose function is not impaired, and whose owner is under 65 years of age. At the same time, hearts can be used for transplantation with some modifications - initial manifestations insufficiency of atrioventricular valves, borderline hypertrophy of the myocardium of the left half of the heart. If the recipient's condition is critical and requires transplantation in as soon as possible, then a not quite “ideal” heart can be used.

The transplanted organ must be suitable in size for the recipient, because it will have to contract in a rather limited space. The main criterion for matching donor and recipient is immunological compatibility, which determines the likelihood of successful graft engraftment.

Before collecting a donor heart experienced doctor will examine him again after the autopsy chest cavity, if all is well, the organ will be placed in a cold cardioplegic solution and transported in a special thermally insulated container. It is advisable that the transportation period does not exceed 2-3 hours, a maximum of six, but it is already possible ischemic changes in the myocardium.

Heart transplant technique

Heart transplant surgery is possible only in conditions of established cardiopulmonary bypass, it involves more than one team of surgeons who replace each other at different stages. The transplantation is lengthy, taking up to 10 hours, during which the patient is closely monitored by anesthesiologists.

Before the operation, the patient’s blood is tested again, coagulation, blood pressure levels, blood glucose levels, etc. are monitored, because there will be long-term anesthesia under artificial circulation. The surgical field is being processed in the usual way, the doctor makes a longitudinal incision in the sternum area, opens the chest and gains access to the heart, on which further manipulations occur.

At the first stage of the intervention, the recipient’s heart ventricles are removed, while great vessels and the atria are preserved. Then, a donor heart is sutured to the remaining organ fragments.

There are heterotopic and orthotopic transplantation. The first method is to preserve the recipient’s own organ, and the donor heart is located to the right below it, anastomoses are performed between the vessels and chambers of the organ. The operation is technically complex and time-consuming, requires subsequent anticoagulant therapy, two hearts cause compression of the lungs, but this method is preferable for patients with severe pulmonary hypertension.

Orthotopic transplantation is carried out both by directly suturing the atria of the donor heart to the atria of the recipient after excision of the ventricles, and bicaval by, when both vena cava are sutured separately, which makes it possible to reduce the load on the right ventricle. At the same time, plasty of the tricuspid valve can be performed in order to prevent its insufficiency later.

After the operation, immunosuppressive therapy with cytostatics and hormones is continued to prevent donor organ rejection. When the patient’s condition stabilizes, he awakens and switches off artificial ventilation lungs, the dose of cardiotonic drugs is reduced.

In order to assess the condition of the transplanted organ, myocardial biopsies are performed - once every 1-2 weeks in the first month after surgery, then less and less often. Hemodynamics are constantly monitored and general condition sick. Healing of the postoperative wound occurs within one to one and a half months.

heart transplant

The main complications after a heart transplant can be bleeding, requiring re-operation and its stop, and graft rejection. Rejection of a transplanted organ - serious problem all transplantology. The organ may not take root immediately, or rejection may begin after two to three or more months.

In order to prevent donor heart rejection, glucocorticosteroids and cytostatics are prescribed. For prevention infectious complications antibiotic therapy is indicated.

During the first year after surgery, patient survival reaches 85% or even more due to improvements in surgical techniques and immunosuppression methods. In the longer term, it decreases due to the development of the rejection process, infectious complications, and changes in the transplanted organ itself. Today, up to 50% of all patients who have undergone a heart transplant live longer than 10 years.

A transplanted heart can work for 5-7 years without any changes, but the processes of aging and degeneration develop in it much faster than in a healthy own organ. This circumstance is associated with a gradual deterioration in health and an increase in the failure of the transplanted heart. For the same reason, the life expectancy of people with a transplant healthy organ still lower than the general population.

Patients and their relatives often have a question: is a repeat transplant possible if the graft wears out? Yes, technically this can be done, but the prognosis and life expectancy will be even shorter, and the likelihood of engraftment of the second organ will be significantly lower, so in reality, repeated transplants are extremely rare.

The cost of the intervention is high, because it itself is extremely complex, requires the presence of qualified personnel and a technically equipped operating room. The search for a donor organ, its collection and transportation also require material costs. The organ itself is given to the donor free of charge, but other costs may have to be paid.

On average, a paid operation will cost 90-100 thousand dollars; abroad, naturally, it is more expensive - it reaches 300-500 thousand. Free treatment carried out under the health insurance system, when a patient in need is put on a waiting list and, in turn, if a suitable organ is available, he will undergo surgery.

Given the acute shortage of donor organs, free transplants are performed quite rarely, and many patients never receive them. In this situation, treatment in Belarus, where transplantation has reached European level, and the number of paid operations is about fifty per year.

The search for a donor in Belarus is greatly facilitated due to the fact that consent to heart removal is not required in the event of brain death. In this regard, the waiting period is reduced to 1-2 months, the cost of treatment is about 70 thousand dollars. To resolve the issue of the possibility of such treatment, it is enough to send copies of documents and examination results, after which specialists can provide indicative information remotely.

In Russia, heart transplantation is performed in only three large hospitals– Federal Scientific Center for Transplantology and artificial organs them. V. I. Shumakov (Moscow), Novosibirsk Research Institute of Circulatory Pathology named after. E. N. Meshalkin and North-Western Federal Medical Research Center named after. V. A. Almazova, St. Petersburg.

Transplantation or heart transplantation is surgical procedure, which involves replacing the patient’s (recipient’s) heart with a donor’s heart. For patients with end-stage heart failure, coronary artery disease, arrhythmia, cardiomyopathy and other serious diseases, a heart transplant is only chance for life. Currently, there is an acute shortage of heart donors, which forces patients for many years be on the transplant waiting list.

Indications for surgery

Heart transplant in mandatory indicated for patients with severe heart failure, which poses a direct threat to life and cannot be treated, for patients with coronary artery disease, valve disease, cardiomyopathy and congenital heart disease. More than 70% of patients waiting in line for a transplant suffer from end-stage heart failure, which is practically untreatable. 25% of them die without waiting their turn.

Such a complex procedure as organ transplantation requires a certain preparatory period, which implies:

staying in a hospital hospital under the supervision of a cardiologist;
donating blood for general analysis;
performing a cardiac catheterization procedure;
passing an echocardiograph test;
passing a survey and written test about the presence of diseases of other organs and systems of the body that may be a contraindication to surgery;
carrying out immunosuppressive therapy.

Donors

The problem of shortage of donor organs arises for a number of reasons affecting the technical and physiological aspects of the transplant procedure:

1. It is impossible to transplant a heart from a living person. No country in the world allows organ transplantation from a living person, as this is considered murder, even if the potential donor himself wants it. The heart is taken from a deceased person whose brain death is officially recorded. A person must give permission during his lifetime to have his organs removed after death.
2. The lifespan of an organ separated from the body is about 6 hours. At the same time, storage and transportation conditions must be ensured, otherwise the heart will become unsuitable for surgery. The organ is transported in a special thermally insulating container, immersed in a cardioplegic solution. Optimal duration the stay of the heart in such a container is 2-3 hours, after which structural changes are possible in the donor heart.
3. The future donor should not have bad habits, diseases of the cardiovascular system, and his age should not exceed 65 years.
4. The main difficulty of transplantology has been and remains histocompatibility, or organ compatibility. You can't transplant a heart from random person, even with immunosuppressive therapy, as this will cause organ rejection. Compatibility is determined by analyzing the blood of the donor and recipient and identifying as much as possible more identical specific protein antigens.

Bypass surgery of cerebral vessels - how is the operation performed and what may be the consequences?

Heart transplant procedure

The procedure is carried out after the preparatory period has passed, and if no contraindications to transplantation have been identified. The operation is performed by several teams of surgeons, cardiologists, anesthesiologists and a dozen assistants, and the procedure itself takes from 8 to 12 hours. The patient is given general anesthesia, which puts him into deep sleep, after which the surgeon opens the patient’s chest and fixes its edges so that they do not interfere with the procedure. After this, the vessels are disconnected from the heart muscle one by one and reconnected to the heart-lung machine. During the operation, the device performs the functions of the patient's heart and lungs. After all the vessels are disconnected, the heart itself is removed, and a donor one is placed in its place. After this, the procedure is repeated in reverse order and the doctor attaches all the vessels to the new donor organ.

Most often, a new heart after a transplant begins to beat on its own, and if this does not happen, the doctor uses an electric shock to stimulate heart rate. Only after the heart beats on its own is the heart-lung machine disconnected from it.

Heart transplant surgery

After the operation, the patient continues to be in the hospital to monitor the transplanted organ. The patient is connected to a cardiac monitor that shows the heart rate and a breathing tube if the patient cannot breathe on his own. A pacemaker is connected to the heart muscle, which will correct its operation, and drainage tubes to drain accumulated fluid and blood during the postoperative period.

Consequences of the operation

The early postoperative period is the most difficult in terms of adaptation of the new organ to the changed operating conditions. If the outcome of the operation is positive and there is no serious complications, normal performance the heart returns in about 3-5 days. It is during this period that complications such as:

donor heart rejection;
thrombosis of the heart arteries;
dysfunction of the brain;
disruption of the lungs, liver, kidneys and other organs.

In the next 7-10 days, complications such as:

infectious infection;
coronary artery disease;
internal bleeding;
pneumonia;
arrhythmia;
development oncological neoplasm against the background of immunosuppressive drugs in the preoperative period.

All these consequences can appear in different orders and at different time intervals after the operation. Complications after transplantation occur in more than 90% of cases, most often arrhythmia, coronary artery disease and internal bleeding. Any complications, to one degree or another, can cause the patient’s death.

Forecast

The life prognosis of patients who have undergone transplantation is positive. If no complications arise in the postoperative period, then the survival rate over a five-year period is more than 80%, and mortality after this period is less than 5%. The most common causes of death in the first five years are rejection, infection, and pneumonia of the heart. About 50% of patients live longer than 10 years after transplantation.

A donor organ in a new body is capable of working for 5-6 years without any serious violations, but the processes of tissue degradation and muscular dystrophy occur in it much faster than they would occur in the body’s native organ. It is for this reason that over time the patient begins to feel weak in the body, dizzy, and his general condition gradually worsens.

Technically, the operation is possible, but the probability that the patient will not die during the operation is unlikely to exceed 50%. Considering that middle age patients on the waiting list are 55-60 years old, then reoperation will be carried out at the age of about 70 years. It is obvious that the body will not only not survive the operation itself, but will not even cope with immunosuppressive therapy. Therefore, to date there are no recorded cases of repeated heart transplantation.

Heart transplantation is a complex, important and expensive procedure. Sometimes this is the only way to save a person's life.

Many people have been waiting for a donor organ for many years due to the fact that there are not enough transplants for everyone. To get on the waiting list, you must consult a cardiologist and fill out special documents. Sometimes a patient can be moved to the top of the list, but only if serious pathologies when there is no time to wait.

Information about first transplants

The first attempts were made in the middle of the last century, but most of them were unsuccessful: the recipients died. This was due to lack of equipment, immunosuppressive therapy, lack of experience and understanding of the problems.

The first successful transplant was registered in 1967, performed by Christian Barnard. This marked the beginning of a new phase in transplantation, and the introduction of cyclosporine in 1983 further accelerated the process.

The drug increased the chances of patients by improving the survival rate of the donor heart.

Despite the development of medicine, there is a large shortage of donor organs in modern transplantation. This is due to the principles of legislation and lack of public awareness of the importance of transplantation.

What is the procedure

Surgery allows you to remove the diseased, damaged heart and replace it with a new one. Basically, the procedure is carried out in the terminal stage of heart failure, the presence of disturbances in the functionality of the ventricles and myocardium.

Ventricular failure can develop with congenital heart disease, a defect in one of the ventricles or valves.

The operation is quite complex and expensive; in addition, it can have many risks, since no one knows whether the organ will take root or not.

In general, the annual survival rate is 88%, 75% of patients remain viable for 5 years, only 56% of all operated patients survive for more than 10 years.

Repeated heart transplantation is also possible, but each time the likelihood of the donor organ surviving decreases. That is why it is rarely performed twice.

Indications for surgery

Basically, the procedure is prescribed to patients with severe heart failure stages 3-4. They experience weakness, tachycardia, and severe shortness of breath. Even with a slight load or at rest in the most advanced stages, the prognosis for survival is poor, so an urgent transplant is necessary.

In addition, the indications for transplantation are as follows:

Dilated cardiomyopathy.
Ischemic disease, myocardial dystrophy in serious condition.
Development benign tumor in the organ area.
Significant rhythm disturbances that do not respond to medical therapy.
Congenital heart anomaly that cannot be corrected with plastic surgery.

Contraindications

Most often, transplantation is performed on patients under 65 years of age. A very important factor is the patient’s desire; if it is absent, the procedure is inappropriate.

Increased pulmonary artery pressure exceeding 4 Wood units.
Infectious diseases in the acute stage, sepsis.
Connective tissue disease or autoimmune pathology, for example, rheumatism, ankylosing spondylitis, scleroderma, lupus.
Malignant formation on the heart.
Chronic pathologies in the stage of decompensation.
A mental illness when contact with the patient before and after transplantation is impossible.
Obesity.

TO absolute contraindications This includes alcohol abuse, smoking, and any drugs.

Preparing for transplant

Before registering or undergoing surgery, patients are required to undergo laboratory and instrumental examinations.

The recipient must undergo:

Fluorography, radiography of the sternum.
Mammography and cervical smear for women, PSA for men. These tests allow us to determine oncological pathologies.
Ultrasound, ECG.
Coronary angiography, through which the condition of the blood vessels can be assessed. If necessary, stenting or bypass surgery is performed.
Catheterization right side heart, when the pressure in the vessels of the pulmonary circulation is determined.
Taking blood tests for hepatitis, syphilis, HIV, coagulation, group and rhesus, general clinical.
Urinalysis.
Examination by a cardiologist, gynecologist, ENT specialist and, if necessary, other specialists.

Very important analysis is immunological typing by HLA system, thanks to which the most suitable donor heart can be determined. Before the transplant, a test is done with the donor's lymphocytes to determine the degree of match between the graft and the recipient.

Who can be a donor

Usually the implanted organ is taken from dead people in case of an accident, serious injury or brain death. The ideal graft is one that is not damaged by coronary disease and has no dysfunction.

It is desirable that the donor does not have heart disease and is under 65 years of age. It is very important that the transplanted organ is the right size.

Always pay attention to immunological compatibility, which shows the percentage of success of the procedure.

Immediately after the heart is removed from the donor, it is placed in a cold cardiac solution and transported to a thermally insulated container. It is important that transportation occurs as soon as possible (no more than 6 hours) after the organ is removed from the human body.

How long does it take to get a donor heart?

If a patient requires a transplant procedure, he is placed on a waiting list at the transplant center. This institution maintains contact with medical organizations, where donors can appear.

You can get a referral to get on the quota line from a cardiologist or cardiac surgeon after consultation and passing all examinations. It is unknown how long they will have to wait in line; some patients may not wait for a transplant and die if the pathology does not tolerate delay.

Most people only have 1-2 years to wait while their condition is maintained with medication. As soon as a suitable donor is found, the operation is immediately carried out either planned or emergency.

How is the wait for a donor heart going?

While waiting and preparing, cardiac pathologies are treated with medication. At chronic failure beta blockers, glycosides, diuretics, ACE inhibitors and calcium antagonists are prescribed.

If the patient gets worse, he is taken to the transplant center for cardiac surgery. There they connect a special device to carry out blood flow through bypass routes. It is in this case that the patient may be moved to the top of the waiting list.

Types of surgery

The most common methods are heterotopic and orthotopic transplantation. In the first case, the native organs remain, and the graft is placed on the lower right. In the second case, the patient’s heart is removed, and the donor’s is fixed in the place where the recipient’s heart was.

The most common is the orthotopic method.

How is the operation performed?

Immediately before the transplant, a blood test, blood pressure and sugar levels are checked. Heart transplantation is performed under general anesthesia and lasts on average from 6 to 10 hours. During this period, the process of artificial circulation should be well established.

First, the doctor treats the desired surface and makes a longitudinal incision, opening rib cage. The patient is connected to a heart-lung machine through the vena cava.

Having gained access to the organ, its ventricles are removed, but the atrium and great vessels are left. The donor heart is sutured at this site. Since there are two types of transplantation, depending on the chosen one, the organs are secured.

In the heterotopic form, the native organ is left in place and the graft is placed to the lower right of the heart. Next, anastomoses are laid between the chambers and vessels. In this case, two organs can cause compression of the lungs. Basically, the operation is performed in patients with severe pulmonary hypertension.

Orthotopic transplantation involves suturing one's own atria to donor ones after removal of the ventricles. The vena cava can be sutured separately, this will reduce the load on the right ventricle.

Sometimes the procedure is combined with tricuspid valve repair to prevent the development of tricuspid valve insufficiency.

Transplant surgery in childhood

In children, the transplant is somewhat more difficult than when the operation is performed on an adult. Therefore, transplantation in children is extremely rarely resorted to, only if the patient suffers end-stage heart disease with limited physical activity. In this case, if refused, the recipient is given no more than 6 months.

An absolute contraindication to surgery for children in early age is the presence of systemic pathologies or uncontrolled infection in an active form.

When a patient is put on the waiting list, the life prognosis is disappointing; he has to wait from 1 week to 1.5 years. 20-50% of these people die before receiving a transplant.

The five-year survival rate in children is about 45-65%, within one year this figure is slightly higher and amounts to 78%. No more than 72% live for about 3 years, and only 25% live longer than 11 years after transplantation.

A very serious problem in the treatment of children is high mortality. In addition, late rejection occurs more often, nephrotoxicity occurs with long-term use cyclosporines, coronary atherosclerosis develops faster.

When surgery is performed on a child within six months after birth, the one-year survival rate is no more than 66%. This is due to vascular inconsistency.

The most dangerous reconstruction of the aortic arch is when deep hypothermia and circulatory arrest are performed.

Scar after transplant

For a heart transplant patient, an incision is made from the neck to the middle of the navel. The scar remains for life, it is quite noticeable. To hide it, you have to wear closed clothes or use various means for skin correction in the damaged area. Some do not hide it and are even proud of it.

How long does rehabilitation take?

After transplantation, there are 4 stages of rehabilitation:

The first one is called “ resuscitation period”, takes from 7 to 10 days.
The second is called the hospital period, lasting up to 30 days.
The post-hospital period extends to 12 months.
And the fourth phase can last more than a year after transplantation.

At the first and second stages, a treatment regimen, immunosuppression and necessary research. In the third phase, the patient is transferred to a maintenance regimen of immunosuppression, but every month it is necessary to undergo hemodynamic assessment and immunological monitoring. At the fourth stage, the patient can already return to his usual labor activity, but some control measures still remain.

After the operation, the patient is left in the department intensive care for a few days. He may be given oxygen for the first 24 hours. During this period, continuous cardiac monitoring occurs to see how the donor heart is functioning. It is important to monitor the functioning of the kidneys, brain and lungs.

For several months after discharge, the patient must undergo special training 1-2 times a week. medical examinations to check for infection and complications in the graft.

Basic rules for recovery after surgery

After transplantation, vasoprotectors and cardiotonics are prescribed. The quantity must be checked ionized calcium to see how the heart works. In addition, it is measured acid-base balance, immunosuppressive therapy is prescribed to prevent organ rejection.

Immediately after awakening from anesthesia, the patient is disconnected from the machine, and the amount of cardiotonics is reduced. To assess the functionality of the graft, they resort to the method of myocardial biopsy.

In addition, the following may be carried out:

Tests for the presence of infection.
X-ray of the lungs.
Electrocardiogram.
Echocardiography.
General biochemical analysis blood, as well as checking the functioning of the kidneys and liver.
Blood pressure control.

Restrictions

To exclude serious consequences and complications, as well as to improve organ engraftment, it is necessary to follow a certain lifestyle:

Take recommended medications: cytostatics and hormones that help weaken your own immunity so that foreign tissue can take root well.
Observe restrictions on physical activity for several months. And on the recommendation of a doctor, you can perform the compiled gymnastics daily.
Monitor your diet, excluding unhealthy foods, for example, fatty, fried, smoked foods.
Protect yourself from infection. Life after surgery changes a lot; the patient should avoid crowded places and sick people in the first months infectious diseases. You should also wash your hands with soap and drink boiled water and consume products that have been heat treatment. This is necessary because due to immunosuppressive therapy, your own immunity becomes weaker and even a minor infection can lead to serious complications.

The benefits of proper nutrition

After transplantation, it is important to stick to a daily routine and only consume healthy food, without burdening cardiovascular system harmful products and dishes.

Fractional nutrition means 5-6 meals during the day. This helps reduce stress and prevent obesity. Long intervals between meals should not be allowed.

The diet implies an exception:

Sausage products.
High-fat dairy products, including hard cheeses.
Fatty meat.
Smoked meats.
Muffins.
Meat by-products.
Egg yolk.
Semolina and rice cereals, pasta.

Alcohol and smoking are strictly prohibited. Carbonated drinks and energy drinks are very harmful. It is better to avoid sweet and salty foods. But if you can’t eat fresh food, then it’s better to switch to iodized salt, but not more than 5 g per day. For sweets, you can eat dried fruits.

It is useful to steam or boil foods. The last meal should take place no later than 2-3 hours before bedtime.

You need to include in your diet:

Vegetables and fruits.
Steamed fish.
Low-fat kefir.
Seafood.
Persimmon.
Nuts.
Garlic.
Tomatoes.
Olive and corn oil.
Barley, barley, buckwheat, oatmeal.
Bran, rye bread.

It is important to reduce the calorie content of food to 2500 Kcal in the postoperative period. Proteins should take up half of the diet, with 25% of them being plant origin. About 40% is allocated to fats daily menu, but they are exclusively plant-based. And carbohydrates remain 10%. Liquids can be no more than 1.5 liters per day.

Do they give disability

Typically, patients who need a transplant already have a disability of the corresponding group. Depending on how the surgery went and how the patient feels after the transplant, medical commission is considering renewal or transfer to another group.

There are no precisely regulated rules for establishing a group in this case, so everything is decided according to the patient’s individual indicators.

Most often, group 2 is given with a review after 1-2 years, but they can be given permanently.

Lifespan

After heart transplantation, survival after 1 year is 85%. Subsequently, some patients experience rejection, changes due to infectious diseases, and the percentage drops to 73.

Life expectancy of more than 10 years is observed in no more than half of all patients who have undergone a heart transplant.

Basically, a new heart functions properly from 5 to 7 years, but it is more susceptible to dystrophy than its own healthy organ.

Gradually, a person may feel a deterioration in their condition, but there are cases when a person, even after so much time, is in excellent health.

Complications after surgery

The most serious consequences Graft rejection is considered. This may not happen immediately, but after several months. Early postoperative complications include bleeding and infection.

If the first happens, the wound is opened again and the bleeding vessel is sutured. To prevent the development of bacterial, viral or fungal infections, antibiotics and immunosuppression are prescribed.

In addition, an oncological disease in the form of lymphoma or myeloma may develop; immunosuppressants contribute to this, as they suppress the immune system. Ischemia may occur if the organ was not implanted immediately, but more than 4 hours after removal from the donor body.

In addition, after surgery you may experience:

Increased pressure on the heart, this is due to the amount of fluid in the space around the organ.
Irregular heartbeat.
Decreased cardiac output.
An increase or decrease in the volume of blood in the circulatory system.

Half of patients develop the disease coronary artery for 1-5 years after surgery.

During the postoperative period, you can suspect that something has gone wrong when:

Chest pain, shortness of breath.
Severe cough.
Swelling.
Migraines and dizziness on a constant basis.
High temperature.
Arrhythmias combined with nausea and vomiting.
Coordination problems.
Increased or decreased blood pressure, deterioration of general health.

Heart transplantation is considered very complex operation. The main difficulty is the lack of a donor organ according to the quota, and half of the patients die without receiving one.

In addition, even if the patient is operated on on time, organ rejection or wound infection may occur, which can lead to fatal outcome. However, a transplant is very often the only salvation for patients with severe heart pathologies. And if everything went well, then the recipient receives a new page of life ranging from 1 year to 11 years, and sometimes more.

Surgeon Christian Barnard ensured his eternal fame by successfully performing what no one had done 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 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 immune system stubbornly rejected a 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 on his own, helps 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 the 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 at such a high level that many patients not only live full life, 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:

P firstvoy successful transplant The organ transplant Barnard performed was a kidney transplant in October 1967. Inspired by the successful result and absolutely confident of a successful outcome and more serious transplantations, Barnard is looking for a patient willing to undergo a heart transplant.

We didn’t have to wait long - 54-year-old Polish emigrant Louis Washkansky, doomed to inevitable death, happily accepts the professor’s offer to make history and become the first heart transplant patient.

Photo: Barnard and Washkansky

D He had no other chance to survive - his heart muscle was so severely damaged. All that remained was to wait for a donor heart, and Washkansky received it from a 25-year-old girl, Denise Ann Darval, who died during a serious car accident. The grief-stricken father (who also lost his wife in this disaster) agreed to the transplant.

And so - half past one on the night of December 3, 1967, both operating teams began work synchronously. First, in the first operating room it was removed sick heart Washkansky, Barnard then removes the donor’s heart in two minutes and transfers it to the next room. Another three hours of painstaking work to implant a new heart, and at half past five the transplanted heart began to beat!

And the next morning Barnard woke up famous - leading newspapers around the world reported in unison about the feat of the South African surgeon. But this was not what interested him, but how the patient’s body would behave in relation to an organ that was vitally important to him, but still completely foreign. After all, the reaction of rejection, which human body everyone is exposed foreign bodies, both artificial and biological, very often nullify the work of even the most skilled surgeon. Fortunately, Washkansky’s body turned out to be quite “loyal”, and the transplanted heart continued to work. And so good that a few days after the operation he was allowed to get out of bed and even take pictures.

Photo: Barnard, December 5, 1967

TO Unfortunately, trouble came from a completely different direction - powerful doses of immunosuppressants weakened the patient’s immunity so much that a few days after the operation he contracted severe pneumonia, from which he was never able to recover. 18 days - exactly how long the first human heart in history beat.

Barnard continued to work despite criticism and failure. And already the second heart transplant was crowned with undoubted success - the patient lived with the new heart for 19 months!..

Photo: Barnard with Grace Kelly. August 8, 1968

B Throughout his life, Arnard considered the Soviet surgeon Vladimir Demikhov (1916-1998) his teacher. Professor Vladimir Onopriev in his book of memoirs “Living According to the Mind and Conscience” writes:

“I learned what a grateful student Christian Bernard turned out to be. On the eve of the world's first heart transplant operation, he calls Demikhov halfway across the globe. Arriving (after the famous operation) once again in Moscow, looking around the rows of welcoming officials and exclaiming:
“Sorry, but I don’t see my teacher, Mr. Demikhov, here. Where is he?

The welcoming officials looked at each other in bewilderment: who is this? Thank God, someone remembered, I had to get out of it: Mr. Demikhov did not come because he was extremely busy at the Institute of Emergency Medicine named after. Sklifosovsky. The guest immediately expressed a desire to immediately return to him. I had to lead. In the dark, cold basement, where the laboratory of the USSR’s first organ transplantology department was located, Bernard found his teacher...”

An incident from Barnard's life:

TO Christian Barnard gave a series of popular lectures in a number of cities South Africa. His driver, a smart and fairly educated guy, sitting in the hall, always listened very carefully to his patron - he knew everything he said at the lectures by heart. Noticing this, Barnard somehow decided to joke and asked the driver to give another lecture in his place.

That evening, the professor, dressed in a driver's uniform, sat in the hall among the audience, and his driver gave a report and answered various questions from the audience. But there was still one listener who asked him very tricky question, to which the speaker found it difficult to answer. However, the resourceful “lecturer” was not at a loss. “Please excuse me, madam,” he replied, “I’m already very tired today.” And I’ll ask my driver to answer your question...