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

HEART TRANSPLANT(syn. heart transplant) - an operation to replace the recipient's heart with a transplant from a donor.

Story

P.'s first attempts with. in the experiment date back to the beginning of the 20th century. - in 1905, A. Carrel and Guthrie (S.S. Guthrie) transplanted a second heart onto the neck of a recipient dog. In 1933, F. S. Mann and co-workers, using this technique, achieved graft functioning for up to 4 days. In 1948, N.P. Sinitsyn developed the original method of P. s. in frogs that lived long time with a functioning graft. This model was proof of the fundamental possibility of life in animals with a transplanted heart. Great contribution to the problem of P. s. contributed by the Soviet scientist V.P. Demikhov. Since 1946, he began extensive experimental research, and in 1955 he was the first to show the fundamental possibility of orthotopic P. s. in a warm-blooded animal and its functioning in the recipient’s body for several hours. With the development of cardiac surgery, anesthesiology and cardiopulmonary bypass methods of experimental research on P. s. were improved. Abroad, the first experimental attempts at orthotopic heart allotransplantation date back to 1953-1958. In 1961, the work of Lower, Shumway (R. R. Lower, N. E. Shumway) et al appeared, describing a new method of P. s. Instead of suturing numerous vessels, they left both atria of the recipient's heart in place, to which they sutured the corresponding sections of the graft's atria, followed by anastomosis of the aorta and pulmonary artery. This method soon entered into the practice of experimental transplantology. Subsequently, the experiment proved that the heart transplant ensures normal blood circulation in the animal’s body for a long time. Reinnervation of the autograft has also been established, occurring after 3-5 months. In an experiment, William (V. L. William, 1964), N. K. Zimin, A. Ya. Kormer (1977) showed the possibility of orthotopic heart allotransplantation in puppies using the method of deep hypothermia (see Artificial hypothermia).

Research was also carried out to develop methods for preserving the heart, and the permissible periods for transplant collection and storage were determined (see Preservation of Organs and Tissues). Received in experimental studies the results allowed Shumway et al. (1964) to approximately determine the list of conditions for which P. s. in patients.

P.S. cannot be a standard cardiac surgery, because there are a number of serious problems limiting its use: tissue incompatibility and lack of effective methods prevention of rejection reactions (see Transplant immunity); unavailability of receiving in required quantity functionally preserved transplants; the need to have at least a short-term working artificial heart (see), a cut by analogy with an artificial kidney (see) would make it possible in emergency situations to maintain blood circulation in the patient’s body until an adequate transplant is found.

An artificial heart could also be used during the treatment of a severe transplant rejection crisis.

In all known cases attempts P. s. Abroad, surgeons used a functioning heart taken from donors diagnosed with the so-called. brain death.

The broad discussion that arose on this issue not only among specialists, but also with the involvement of various sectors of society, shaped public opinion about non-compliance with moral, ethical and legal standards when performing P. p. in wedge, practice. In addition, in a number of countries, including the USSR, legislation does not recognize the diagnosis “ brain death"for the criterion of biol, the death of the organism, which gives the right to raise the question of the possibility of organ removal. In these countries, with existing legislation, it is actually possible to carry out P. s. in patients only after the development of methods for restoring full contractile function a transplant removed from a donor whose heart has stopped beating.

This issue requires further in-depth study. Due to what is stated in the USSR, this operation cannot be used in clinical practice.

At the same time, P. s. is practiced in a number of countries. The first attempt at clinical P. s. was undertaken on January 23, 1964 by Amer. heart surgeon J.D. Hardy, who replaced the heart of a heart-sick chimpanzee. The graft functioned for one hour. In December 1967, Barnard performed the first human-to-human orthotopic heart transplantation. The patient lived for 18 days.

In 1974-1975 he also performed two P. s. operations. according to the new option - transplantation of the second extra heart, working parallel to the recipient’s own heart and unloading its left ventricle (Fig. 1).

According to Barnard et al. (1979). The advantage of this technique is that immediately after transplantation, when the donor heart is not contracting actively enough, the left ventricle of the recipient’s heart provides optimal blood flow. In case of hypertension of the pulmonary circulation in the recipient, when orthotopic P. s. contraindicated, the right ventricle of the transplant adequately overcomes the increased resistance in the vessels of the pulmonary circulation. If it is necessary to help the right ventricle of the recipient’s heart in overcoming this resistance, then the superior vena cava of the graft is additionally anastomosed end to side with the superior vena cava of the recipient’s heart, and the pulmonary artery of the transplant is anastomosed end to side with the pulmonary artery of the recipient. This transplantation technique creates long-term unloading of the recipient's heart. Thus, Barnard implemented the ideas of V.P. Demikhov (I960), using for the first time in wedge practice the principle of heterotopic heart transplantation.

Indications

The question of formulating precise and correct indications for P. s. seems very difficult. As can be seen from the history of the development of surgery, views on the indications for surgery are formed over the years and change over time depending on the development of medicine. Sciences. Mainly P. s. in countries where it is permitted, it is performed on patients in whom any physical activity is accompanied by a feeling of discomfort (according to New York functional classification heart failure, these patients belong to group IV).

Symptoms of heart failure or coronary pain in these patients they manifest themselves at rest, intensifying with the slightest load. However, not all of them can be recognized as candidates for P. s. Thus, according to the Stanford Center (USA), out of every 100 patients examined during the year, the various reasons OK. 75%, hospitalized approx. 25%, and surgery is performed in approximately 15% of patients. According to Gripp (R.V. Gripp, 1979), in the future P. s. will be more often performed for congenital heart defects, and heterotopic P. s. preferable for reversible acute disorders heart functions.

These countries have developed the following contraindications to P. s.: age over 50-55 years; systemic diseases and infections; high resistance in the pulmonary vessels (more than 8-10 international units); fresh pulmonary infarction and severe damage to peripheral blood vessels; insulin-resistant diabetes.

Thus, P. s. used in these countries only in the terminal stage heart disease and is relatively emergency in nature.

By the end of 1979, 406 orthotopic P. s. had been performed worldwide. 395 patients, including some repeatedly. Of the 395 patients, 100 people were alive for periods ranging from several months to more than 10 years. Since 1974, 20 heterotopic heart transplantations have been performed. There was no operative mortality. Of the operated patients, 62% lived for a year, 58% for two years, and 50% for three years. Active program for P. s. the clinic performs 5 centers ( greatest experience has a center at Stanford University, headed by Shumway, in which 153 operations were performed by the end of 1978).

Methodology

With P. s. generally accepted methods of anesthesia are used for large cardiac surgery. The operation consists of several stages: collecting the heart from the donor, ensuring protection of the graft myocardium in the pre- and intra-transplantation periods, removing the recipient’s heart (or part of it), and suturing the graft.

The heart can be taken from a donor only after brain death has been established, which is established on the basis of neurol, research, the presence of an isoelectric line on the EEG, cerebral angiography data, or the nature and extent of brain damage established during surgery.

Taking the graft and protecting it for the period of transfer, i.e. during the time from the moment of removal of the graft to the moment of its inclusion in the recipient’s bloodstream, is carried out in the following way: after median sternotomy (see Mediastinotomy), the donor's aorta is crossed immediately below the origin of the brachiocephalic trunk, then the pulmonary trunk proximal to its bifurcation and, retracting the stumps of these vessels, the atria are cut off as distally as possible from the coronary groove (atrioventricular groove). The graft with open cavities is placed in a special cold solution(t° 4-10°). When taking a graft under the protection of coronary perfusion (see), the technique is more complicated and requires preliminary catheterization of the vessels. However, none of these methods can be preferred and the most appropriate one in specific conditions should probably be used.

When preparing the transplant, the right atrium is opened, directing the incision from the mouth of the inferior vena cava obliquely upward to the base of the right appendage, which prevents damage to the conduction pathways of the heart (Fig. 1, a).

Removal of the recipient's heart is carried out after turning on artificial circulation (see); The operation begins with the intersection of the aorta and pulmonary trunk at the level of the valves. Then they open it right atrium along the atrioventricular groove, the left atrium is partially cut off. The septum is cut off leaving as much tissue as possible. Most surgeons believe necessary removal the appendage of both atria of the recipient due to the possibility of blood clots coming from them.

Sewing the graft differs among different surgeons only in the sequence and timing. The technique of Lower et al. is mainly used. (1961), in which sewing begins with the application of stay sutures to the atria (see Fig. 1, a), then the left atria and right atria are sequentially anastomosed using a continuous double-row wrapping suture (Fig. 1, b). The pulmonary trunk and aorta are also sutured using one of the variants of the vascular suture (see), most often with a continuous double-row wrapping suture (Fig. 1, c, d). An important point surgery is to prevent air embolism coronary arteries transplant - drainage of the left ventricle followed by removal of air by puncture of the ventricles and aorta. Restoration of cardiac activity is carried out using electrical defibrillation (see), followed by suturing the myocardial electrodes of the pacemaker (Pacemaker) to the graft (see Cardiac pacing).

With heterotopic P. s. first, holes are made in the left atria of the graft and the own heart and the atria are sutured to each other; then the pulmonary trunk of the graft is anastomosed with pulmonary trunk recipient, and the ascending aorta of the graft - with the recipient aorta (Fig. 2).

Postoperative management

The main thing in managing the immediate postoperative period is to ensure optimal cardiac output, which is achieved by maintaining high central venous pressure (due to infusion sufficient quantities fluid), maintaining the contractile function of the transplant (administration of isoproterenol and cardiac glycosides), normalizing the rhythm of the transplanted heart with a frequency of at least 100 contractions per minute, controlled by ventilation (see Artificial respiration). A feature of the post-transplant period that determines the outcome of the operation in these patients is the possibility of developing a graft rejection reaction (see Immunological incompatibility) and the need long-term use immunosuppressive substances (see) and agents. Monitoring of immunol, the patient’s condition creates the opportunity early diagnosis And timely treatment crisis of rejection. Signs of acute heart transplant rejection vary. They are divided into clinical, electrocardiographic, echocardiographic, morphological and immunological. TO clinical signs include a decrease in the precordial impulse, an increase in end-diastolic pressure, signs of right ventricular failure followed by left ventricular failure; to electrocardiographic - decreased voltage of the QRS complex, displacement electrical axis heart to the right, atrial, less often ventricular arrhythmias, blockade of the cardiac conduction system varying degrees; to echocardiographic - an increase in the diameter of the right ventricle and the thickness of the wall of the left ventricle; morphological - dystrophic and necrobiotic changes in muscle fibers, focal lymphohistiocytic infiltrates in the stroma; immunological - an increase in the level of lymphotoxins, the number of T-lymphocytes, a decrease in the titer of the spontaneous rosette formation inhibition reaction.

With P. s., like any other organ, vital importance has optimal immunosuppressive therapy, which includes the administration of steroids, azathioprine, methylprednisolone, antilymphocyte serum (see Immunotherapy). The dosage and regimen of the drugs vary, but generally 200 mg of azathioprine, 200 mg of methylprednisolone administered intravenously immediately before surgery, and then azathioprine at a dose of 2-3 mg/kg per day are used. The administration of methylprednisolone is gradually limited: a week after surgery and in the next 3 months. reduce to 10 mg every 8 hours. Antilymphocyte serum is administered intravenously immediately after surgery, and then in decreasing dosages over 6-8 weeks. If signs of rejection appear, methyl prednisolone is prescribed 1 g daily for 3-4 days. Other medications, including heparin, are given in maintenance doses.

Complications

Complications of the postoperative period, according to J. Rottembonrg et al. (1977), can be divided into two groups - effusion into the pericardial cavity and inf. complications.

The formation of pericardial effusion is most often associated with heparin treatment. The main way to combat this complication is drainage of the pericardial cavity. As a rule, drains are removed only after a few days.

The most dangerous and common complications of the postoperative period with P. s. include inf. complications, among which the most dangerous is pneumonia. Inf. complications remain one of the main causes of death both in the immediate and long term after surgery. During the first year after P.'s operation. the main cause of graft dysfunction is, according to F. T. Thomas and Lower (1978), atherosclerosis of the coronary arteries. Prevention of its development can be achieved by introducing anticoagulants, anti-aggregants, as well as special diet, low in fat.

Social and prof. rehabilitation of patients after P. s. occurs on average after 6 months. In some cases, patients can practice their profession. activities.

Bibliography: Burakovsky V. I., Frolova M. A. and F a l k about fi-ski y G. E. Heart transplantation, Tbilisi, 1977, bibliogr.; Demikhov V.P. Transplantation for life important organs in experiment, M., 1960; 3 i m n N. K, and K o rmer A. Ya. Autotransplantation of the heart in an experiment, Cardiology, v. 17, no. 7, p. 126, 1977; Zimin N.K., K o r m e r A. Ya. and L i p o v e c k i y G. S. Intrathoracic transplantation of an additional heart in an experiment, Eksperim, hir. and anesthesiol., No. 5, p. 10, 1976; Malinovsky N. N. and Konstantin ov B. A. Repeated operations on the heart, M., 1980; Petrovsky B.V., Knyazev M.D. and P1 a b a l k and n B.V. Surgery of chronic ischemic heart disease, M., 1978; Sinitsyn N.P. Heart transplantation as a new method in experimental biology and medicine, M.-L., 1948; Emergency surgery of the heart and blood vessels, ed. M. E. De Beki and B. V. Petrovsky, M., 1980; Barnard S. N. The present status of heart transplantation, S. Afr. med. J., v. 49, p. 213, 1975; aka, Heterotopic versus orthotopic heart transplantation, Transplant. Proc., v. 8, p. 15, 1976; Barnard C. N. a. W o 1 p o-w i t z A. Heterotopic versus orthotopic heart transplantation, ibid., v. 11, p. 309, 1979; D o n g E. a. S h u m w a y N. E. Hemodynamic effects of cardiac autotransplantation, Dis. Chest, v. 46, p. Ill, 1964; G r i e p p R. B. A decade of human heart transplantation, Transplant. Proc., v. 11, p. 285, 1979; Hardy J. D. The transplantation of organs, Surgery, v. 56, p. 685, 1964, bibliogr.; Herz und herznahe Gefasse. Allgemeine und spezielle Opera-tionslehre, hrsg. v. H. G. Borst u. a., Bd 6, B., 1978; Lower R. R., Stoper R. C. a. S h u m w a y N. E. Homovital transplantation of the heart, J. thorae. cardiovasc. Surg., v. 41, p. 196, 1961; Lower R.R.a. o. Selection of patients for cardiac transplantation, Transplant. Proc., v. 11, p. 293, 1979; Mann F. C. a. o. Transplantation of intact mammalian heart, Arch. Surg., v. 26, p. 219, 1933; Rottembourg J. e. a. Aspects actu-els de la transplantation cardiaque humaine, Nouv. Presse med., t. 6, p. 633, 819, 1977; Shumway N.E. a. Lower R. R. Special problems in transplantation of the heart, Ann. N. Y. Acad. Sci., v. 120, p. 773, 1964.

V. I. Shumakov.

The first of which, 50 years ago, was successfully performed by a South African cardiac surgeon, a European by birth, Christian Netling Barnard, have long since become routine. It seems that science has come a long way in this direction since then, and we are about to enter the era of high-tech and reliable mechanical hearts. Or we’ll grow an artificial one. But is this really so?

Vessel of love and fearlessness

The first adult heart transplant was performed in Cape Town. It was an epoch-making day not only for science, but also for spiritual culture. And no wonder: for people over the centuries the heart has been not just an organ that pumps blood, but a kind of symbol to which human imagination has assigned a special role.

Despite the fact that by 1967, when the first transplant operation was performed, humanity had a fairly extensive knowledge of the function of the heart, some continued to believe that this organ is the center of high feelings and courage. And even in 1982, the wife of a certain Barney Clark, a former dentist who received the world's first artificial heart (Clark had end-stage heart failure), was very worried that after such an operation her husband would no longer feel love for her.

Today, a heart transplant is the only treatment for most severe cases of heart failure, which, according to some estimates, affects about nine million people in Russia alone. However, at the very beginning of the 60s of the last century a heart transplant was considered an unattainable dream. The risk of organ rejection and life-threatening infections was simply prohibitive. However, already in the second half of the decade, humanity took its decisive step towards heart transplantation.

Heart transplant surgery

Transplantation “arms race”

The development of cardiology has led to a kind of race to see who will be the first to perform a heart transplant (a sort of “arms race” in cardiac surgery). Four or five surgeons in the world could be called unique leaders of the race. But Christian Barnard turned out to be the bravest, luckiest and most talented. The second was American surgeon Norman Edward Shumway, who performed the first heart transplant in United States history in 1968. They both completed clinical residencies at the University of Minnesota, but the relationship between them was cold, for which there were reasons.

Shumway despised Barnard for his “ostentation, defiant behavior and willingness to cheat.” Dr. Barnard, in turn, was outraged that Norman seemed to see him in the first place a second-class foreigner from a country. In addition, Barnard's status as a specialist was lower due to the fact that his American colleague had much more extensive experience in animal heart transplants.

In 1959, Dr. Shumway and Richard Lower of Stanford University performed the first heart transplant in a dog. The animal with the transplanted heart lived for eight days, and scientists thereby proved to all humanity that this organ can be transplanted from one animal to another without losing its functionality. And by 1967, approximately two thirds of the dogs that went through operating table Dr. Shumway, could live whole year or even more. By that time, the American scientist had managed to transplant hearts into three hundred dogs. Barnard carried out about 50 similar operations.

By the end of 1967, Dr. Shumway announced that he was going to begin clinical trials at Stanford that would ultimately lead to human heart transplantation. Shumway, although he believed that animal surgery must and will continue, however, he stated that he had already approached the border beyond which it begins clinical application his experience. It is believed, however, that the American was at a disadvantage because he had difficulty finding donors human heart.

Dead brain, living heart

Indeed, at that time, American legal norms prohibited the removal of organs from those patients whose brain death was recorded, but the heart still continued to beat. In order to take the heart, it was necessary for it to stop beating completely. Theoretically, the situation could have developed in such a way that a surgeon who neglected these rules would have ended up behind bars for murder.

Dr. Barnard acted under more liberal legislation South Africa. He was a visionary in advocating this approach through legislation that allowed a neurosurgeon to declare a patient dead if the patient showed no response to light or pain. And if only the consent of the family or next of kin of such a patient was obtained, a team of transplant doctors could quickly remove the necessary organs, including the heart, through which blood was still circulating.

We can say that the competitors had almost equal chances, but Dr. Barnard came to the “finish line” first, on December 3, 1967. His first patient was a certain Louis Washkansky, a 55-year-old grocer who got the heart of a young woman, who died from a traumatic brain injury received in a car accident. Washkansky lived 18 days after this operation, dying from a lung infection that arose against the background of weakening immune system body due to drugs taken to prevent organ rejection.

Less than a month had passed since Dr. Shumway performed the first heart transplant on the American continent - on January 9, 1968. However, the talented surgeon was forced to settle for only second place. His patient, a 54-year-old steelworker, lived 14 days after the transplant. After the patient died, Dr. Shumway acknowledged the presence of, as he himself put it, “a fantastically cosmic number of complications.”

How long do they live after a heart transplant?

Mechanical heart or grown one?

These days, considering the quality medical supplies, which prevent the patient's body from rejecting the foreign organ, the life expectancy of some heart transplant patients is truly amazing.

About 85 percent of patients live for at least a year after such a complex procedure. The average life expectancy after such an operation is from 12 to 14 years, if the patient survives the first year after the organ transplant.

Despite the fact that heart transplant surgery has saved many lives, many more people have died while waiting for such an operation. For example, in the USA alone Approximately 3,000 such operations are performed annually; and about 4,000 people are constantly on the transplant waiting list. Despite a public company designed to increase the number of donor hearts, the average number of available organs per year remains roughly the same.

If we take into account the total number of Americans suffering from heart failure, then, as one Lynn Stevenson, a specialist in heart failure, put it, cardiovascular diseases one of the most prestigious research universities USA – Vanderbilt University, “heart transplant surgery is the same answer to heart failure as the lottery is the answer to poverty" It turns out there is hope for development this direction medicine through donor hearts is utopian.

It is for this reason that the most ambitious projects are scientists’ plans for the mass replacement of a diseased human heart with a ready-to-use one. mechanical device. Cardiologists and surgeons dream about this. And although functioning mechanical hearts were introduced to the world back in the 1980s, their use still poses unforeseen complications. Today, the most reliable mechanical heart is often a left ventricular assist device, which is attached to the patient's heart, pumping blood directly into the aorta.

However, these devices have a drawback: they lead to the formation of blood clots, provoke a stroke and cause bleeding. Such devices are ineffective when it comes to patients suffering from heart failure, which simultaneously disrupts the functioning of the right and left ventricles of the heart. Growing artificial heart also remains a matter of the distant future, resembling, rather, a fantastic project.

One of the many problems, for example, is that it has not yet been possible to solve the problem of simultaneous cultivation muscle tissue and the so-called vascular bed, thanks to which metabolism will occur. There are messages here and there that Over the next 10 years or more, scientists will solve most problems. In the meantime, for most patients, the only real hope is a donor heart transplant; the hope that a pioneer from the heart of South Africa gave the world half a century ago.

Heart transplant in Russia

Do you know that...

Dr. Christian Barnard considered his mentor the experimental scientist Vladimir Petrovich Demikhov, who is, in fact, the founder of transplantology. Barnard visited Demikhov twice in his laboratory in the USSR in the early 60s of the last century. It was Vladimir Demikhov who performed the world's first operation related to mammary coronary bypass surgery (1952).

First successful operation heart transplant was performed in Russia in March 1987 academician Valery Ivanovich Shumakov. Founded in the same year, the Research Institute of Transplantology and artificial organs today bears his name. This is the most major center in Russia, which performs more than 500 transplant operations per year various organs.

The most successful heart surgery

One of the longest heart transplant operations was performed in 1987 by Polish surgeon Zbigniew Relig, who later became the Minister of Health of Poland. After a 23-hour operation, Relig's assistant fell asleep right in the corner of the hospital room. His patient, a certain Tadeusz Zhutkiewicz, died in 2009. At that time, Zhutkevich was 70 years old, of which he lived for 22 years with a donor heart. Tadeusz was six years short of becoming a “long-liver” among people living with a heart transplant. However, we must make allowances for old age...

7 human heart transplants!

Record holder for the number of hearts

The undoubted record holder for the number of heart replacement surgeries performed is the late billionaire David Rockefeller. Rockefeller underwent the first operation to replace this vital organ back in 1976. Since then, he has had to undergo six more similar operations. The last time the billionaire had his heart changed was at the age of 99, in 2015. Rockefeller lived with him for two more years, dying at the age of 101.

Exactly thirty years ago - on March 12, 1987 - the first successful heart transplant was performed in the USSR. It was conducted by Honored Surgeon, Academician Valery Shumakov. Alexandra Shalkova is our first compatriot who received a vital organ transplant, after which she lived for eight and a half years. At the age of 25, the girl developed dilated cardiomyopathy - a disease due to which all the cavities of the heart expand and it is not able to pump blood throughout the body.

“As I remember now, it was on the night from Friday to Saturday,” recalled academician Valery Shumakov in an interview with Ogonyok. — We performed the operation, transferred the patient to intensive care, and she woke up. And early in the morning a call from the ministry: “What are you doing there?” We answer that everything went fine. The responsible comrade immediately arrived, entered the room, and looked at the patient. He turns and says: “I need a phone.” They gave him a phone and he started calling the science department of the CPSU Central Committee. Having finished the conversation, he turned and said: “The management asked me to convey congratulations to you...”

“The first heart transplant operation, performed by Valery Ivanovich Shumakov, is certainly of historical significance,

since all similar attempts up to this point (there were several of them) ended tragically,” surgeon Leo Bockeria recalled the operation.

However, the USSR lagged very far behind world practice in transplantology, which was due to legislation and the lack of donor centers. For more than two decades, Shumakov and his associates sought recognition of the diagnosis of brain death as sufficient grounds for organ removal. Inexplicable from the point of view common sense reasons, this concept was considered not to correspond to the norms of socialist morality. As a result, a dead-end situation for transplantology arose: the liver, heart and lungs must be removed only from a donor with a beating heart, and this is impossible to do.

Only in 1987 did they begin to declare death with a diagnosis of “brain death,” and literally a few months later Shumakov transplanted the first heart.

The first such operation in the world was carried out twenty years earlier. Surgeon Christian Barnard at Groote Schuur Hospital in Cape Town successfully transplanted a heart in 1967 to businessman Louis Washkansky from a woman who had just died in a car accident near the hospital. True, after the transplant, Vashkansky lived only 18 days and died from developing pneumonia and rejection of the new organ. The second patient lived for 19 months, and came to Christian Barnard world fame, in South Africa in the late eighties he became so popular that souvenirs with the image of his hands began to be sold there.

But all his life, the South African surgeon considered the Soviet experimental scientist Vladimir Demikhov his teacher; he called him “the father of world transplantology” and came to him in Soviet Union twice, and also called the day before surgery to get recommendations.

After all, it was Demikhov who, in 1962, performed the world’s first successful heart and lung transplant into a dog,

which became a worldwide sensation and subsequently allowed people to carry out similar operations. The monograph “Experimental Transplantation of Vital Organs,” published in 1960, was immediately translated into several languages ​​and published in Berlin, New York and Madrid. The outstanding scientist began conducting his experiments back in 1946, when he transplanted a second heart into a dog, and a few years later he conducted an experiment on liver transplantation.

However, in the USSR, Demikhov was persecuted; for a long time he was not allowed to defend his dissertation and conduct experiments. Also, it was the Soviet surgeon Sergei Yudin who, back in the 20s of the last century, proved that microbes enter the blood only twenty hours after a person’s death; he was even able to save a patient with serious blood loss by transfusing him with the blood of the deceased. These experiments also proved the possibility of organ transplantation from the deceased.

“As for Alexandra Shalkova, she could live today. But Shura got married and one day did not take the prescribed pill on time to suppress the rejection reaction. She was ruined by ordinary carelessness,” Shumakov said.

IN modern world Heart transplant operations are considered ordinary; according to the International Society of Heart and Lung Transplantation, 3,800 of them are performed per year, and in Russia - about 150. “This is a large operation, but it is no more complicated than those performed today in many clinics. It has been worked out to the smallest detail. Management of the postoperative period is very well known. There are known complications,” says surgeon Leo Bockeria.

There are cases when patients live more than twenty years after a transplant. American Tony Husman holds the record for life expectancy.

lived 30 years after a heart transplant and died of skin cancer.

American billionaire David Rockefeller received seven heart transplants during his life, the first of which he received in 1976 when he was in a car accident, and the last at the age of 101.

“Each new heart seems to “breathe” life into my body. “I feel more alive and energetic,” the businessman shared his impressions after the operation.

Transplantology does not stand still, and in June 2008 the world's first transplant operation was performed human organ grown from stem cells - trachea. Professor Martin Birchall, who helped grow it, says that within twenty years, using this technology, people will learn to create almost all transplantable organs.

P firstvoy successful transplant The organ transplant Barnard performed was a kidney transplant in October 1967. Winged successful result and absolutely confident of a successful outcome and more serious transplants, 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 had 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 diseased 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 in 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...

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 disease heart disease, arrhythmia, cardiomyopathy and other serious diseases, a heart transplant is only chance for life. Currently there is acute shortage heart donors, which forces patients long years be on the transplant waiting list.

Indications for surgery

Heart transplantation is mandatory 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. 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. 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. 3. The future donor should not have bad habits, diseases of cardio-vascular system, and his age should not exceed 65 years.
4. 4. The main difficulty of transplantology has been and remains histocompatibility, or organ compatibility. You cannot transplant a heart from a 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 dream, after which the surgeon opens chest patient 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 connects all the vessels to a new one 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 it. 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 into the heart muscle. 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 are 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 average age Patients on the waiting list are 55-60 years old, then reoperation will be performed 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.