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

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

Attempts to transplant organs were made as early as the middle of the last century, but the lack of 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. She was 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. Transplants began to be carried out all over the world, including in Russia.

The main problem modern transplantology is the lack of donor organs, often not because they are not physically present, 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 organ harvesting for transplantation to needy patients, even being informed of the possibility of saving several lives at once. In Europe and the United States, these issues are practically not discussed, people voluntarily give such consent during their lifetime, and in the countries of the post-Soviet space, specialists have yet to overcome a serious obstacle in the form of ignorance and unwillingness of people to participate in such programs.

Indications and obstacles to surgery

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

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

When determining the indications, the age of the patient is taken into account - it should not be more than 65 years old, although this issue is resolved individually, and under certain conditions, transplantation is performed for older people.

Others no less an important factor consider the desire 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 go for transplantation or refuses to perform necessary procedures, including in the postoperative period, then the transplantation itself becomes inappropriate, and the donor heart can be transplanted to another person in need.

In addition to indications, a range of conditions that are incompatible with heart transplantation have been identified:

Age over 65 years (relative factor, taken into account individually);
Steady increase in pressure in pulmonary artery over 4 units Wood;
Systemic infectious process, sepsis;
Systemic diseases connective tissue, autoimmune processes (lupus, scleroderma, Bechterew's disease, 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;
Unwillingness of the patient to perform the operation and follow the further treatment plan.

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

Preparing for a Donor Heart Transplant

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

The recipient needs to:

General clinical studies of blood, urine, clotting test; determination of blood group and Rh-affiliation;
Tests for viral hepatitis acute phase- contraindication), HIV (infection with the immunodeficiency virus makes the operation impossible);
Virological examination (cytomegalovirus, herpes, Epstein-Barr) - even in an inactive form, viruses can cause an infectious process after transplantation due to immunosuppression, so 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.

Apart from laboratory tests, held instrumental examination: coronary angiography, which allows to clarify the state 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, respiratory function.

Among the invasive examinations are used right catheterization 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 circulation, at a pressure in the range of 2-4 units. the risk of complications is high, but transplantation can be performed.

The most important stage in the examination of a potential recipient is immunological typing system HLA, according to the results of which a suitable donor organ will be selected. Immediately before transplantation, a cross-test with donor lymphocytes is performed to determine the degree of compliance of both participants in organ transplantation.

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

In case of deterioration of the patient's health, they can be hospitalized in an organ and tissue transplantation center or a cardiosurgical hospital, where it is possible to install a special device that provides blood flow in bypass ways. In some cases, the patient may be "moved" up the waiting list.

Who are 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 wants to donate it to someone. The source of hearts for transplantation is usually people who died from injuries, in road accidents, victims of brain death. An obstacle to transplantation may be the distance that the donor heart will need to overcome on the way to the recipient - the organ remains viable for no more than 6 hours, and the smaller this interval, the more likely the success of transplantation.

An ideal donor heart will be an organ that is not affected by coronary disease, whose function is not impaired, and the age of its owner is up to 65 years. At the same time, hearts can be used for transplantation with some changes - initial manifestations atrioventricular valve insufficiency, borderline myocardial hypertrophy 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 fit the size of the recipient, because it will have to shrink in a rather limited space. The main criterion for matching the donor and recipient is immunological compatibility, which predetermines the probability of successful transplant engraftment.

Before donation heart harvesting experienced doctor re-examine it after opening chest cavity if all is well, the organ will be placed in a cold cardioplegic solution and transported in a special thermal insulating container. It is desirable 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

A heart transplant operation is possible only under conditions of well-established cardiopulmonary bypass, it involves more than one team of surgeons who replace each other at different stages. Transplantation is long, takes up to 10 hours, during which the patient is under the close supervision of anesthesiologists.

Before the operation, blood tests are taken from the patient again, coagulability, blood pressure, blood glucose levels, etc. are monitored, because there will be long-term anesthesia under conditions of cardiopulmonary bypass. The operating field is being processed in the usual way, the doctor makes a longitudinal incision in the sternum, opens the chest and gains access to the heart, on which further manipulations take place.

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

Distinguish heterotopic and orthotopic transplantation. The first way is to preserve the recipient's own organ, and the donor heart is located to the right below it, anastomoses are applied 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 suturing directly the atria of the donor heart to the atria of the recipient after excision of the ventricles, and bicaval through when both vena cava are sutured separately, which makes it possible to reduce the load on the right ventricle. At the same time, plastic surgery 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 rejection of the donor organ. When the patient's condition stabilizes, he wakes up, turns off artificial ventilation lungs, doses of cardiotonic drugs are reduced.

In order to assess the state of the transplanted organ, myocardial biopsy is performed - once every 1-2 weeks in the first month after the operation, then less and less frequently. Hemodynamics is constantly monitored and general state 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 a second operation and stopping it, and graft rejection. Rejection of a transplanted organ serious problem all transplants. The organ may not take root immediately, or rejection will begin after two to three or more months.

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

During the first year after surgery, the survival of patients reaches 85% and even more thanks to the improvement of surgical techniques and methods of immunosuppression. 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 is able to work for 5-7 years without any changes, but the processes of aging and dystrophy 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 insufficiency of the transplanted heart. For the same reason, the life expectancy of people with transplanted healthy body still below the general population.

Patients and their relatives often have a question: is it possible to re-transplant if the graft wears out? Yes, it is technically possible to do this, but the prognosis and life expectancy will be even less, and the probability of engraftment of the second organ is significantly lower, therefore, in reality, repeated transplantations are extremely rare.

The cost of intervention is high, because it is extremely complex, requires the presence of qualified personnel, 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 expenses may have to be paid.

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

Given the acute shortage of donor organs, free transplants are quite rare, and many patients never wait for them. In this situation, treatment in Belarus, where transplantology 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 by the fact that consent to the removal of the heart is not required in case of brain death. Due to this, 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 only in three large hospitals– Federal Research Center of Transplantology and artificial organs them. V. I. Shumakova (Moscow), Novosibirsk Research Institute of Circulatory Pathology. E. N. Meshalkin and the North-Western Federal Medical Research Center. V. A. Almazova, St. Petersburg.

A transplant or heart transplant is surgical procedure, implying the replacement of the heart of the patient (recipient) with the heart of a donor. For patients with end-stage heart failure, coronary heart 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 long years be on the waiting list for a transplant.

Indications for surgery

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

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

stay in the hospital under the supervision of a cardiologist;
blood donation for general analysis;
conducting a cardiac catheterization procedure;
passing the test on the echocardiograph;
passing a survey and a written test about the presence of diseases of other organs and systems of the body, which may be a contraindication to surgery;
conducting 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, during his lifetime, give permission for the removal of his organs after death.
2. The life span of an organ separated from the body is about 6 hours. At the same time, storage and transportation conditions must be provided, otherwise the heart will become unsuitable for surgery. The organ is transported in a special thermal 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 must not have bad habits, diseases of the cardiovascular system, and his age should not exceed 65 years.
4. The main difficulty of transplantation 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 how more the same specific protein antigens.

Cerebral vascular shunting - how is the operation performed and what could be the consequences?

Heart transplant procedure

The procedure is carried out after the passage of the preparatory period, and if there are no contraindications to transplantation. 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 in deep dream, after which the surgeon opens the patient's chest and fixes its edges so that they do not interfere with the procedure. After that, the vessels are alternately disconnected from the heart muscle 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 that, 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 operation

After the operation, the patient continues to stay in the hospital to monitor the transplanted organ. A heart monitor is connected to the patient, which 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 work and drainage tubes to drain the accumulated fluid and blood in the postoperative period.

Consequences of the operation

The early postoperative period is the most difficult in terms of adapting a new organ to the changed conditions of functioning. With a positive outcome of the operation and the absence serious complications, normal performance heart returns after about 3-5 days. It is during this period that complications such as:

rejection of a donor heart;
thrombosis of cardiac 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 on the background of immunosuppressive drugs in the preoperative period.

All these consequences can manifest themselves in a different order and at different time intervals after the operation. The occurrence of complications after transplantation occurs in more than 90% of cases, most often it is arrhythmia, coronary artery disease and internal bleeding. Any complications to one degree or another can cause the death of the patient.

Forecast

The life prognosis of transplant patients is positive. If there are no complications in the postoperative period, then the five-year survival rate is more than 80%, and the 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 organism is able to work for 5-6 years without any serious violations, but the processes of tissue degradation and muscular dystrophy proceed in it much faster than would occur in the body's native organ. It is for this reason that over time the patient begins to feel weakness in the body, dizziness, and his general condition gradually worsens.

Technically, the operation is possible, but the probability that the patient will not die during the operation is hardly more than 50%. Considering that average age patients on the waiting list is 55-60 years old, then reoperation will be held at the age of about 70 years. Obviously, the body will not only not endure 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 join the queue, you need to 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 the 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 the lack of equipment, immunosuppressive therapy, lack of experience and understanding of the problems.

The first successful transplant was registered in 1967 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 allowed to increase 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 the lack of public awareness of the importance of transplantation.

What is the procedure

Surgery allows you to remove a diseased damaged heart, replace it with a new one. Basically, the procedure is carried out in the terminal stage of heart failure, the presence of violations in the functionality of the ventricles, 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 live for more than 10 years.

Repeated heart transplantation is also possible, but the probability of survival of the donor organ decreases each time. That is why it is carried out twice quite rarely.

Indications for surgery

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

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.
An anomaly of the heart of a congenital nature that cannot be removed with plastic surgery.

Contraindications

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

Elevated pulmonary artery pressure greater than 4 Wood's units.
Infectious diseases in the acute stage, sepsis.
Connective tissue disease or autoimmune pathology, for example, rheumatism, Bechterew's disease, scleroderma, lupus.
Malignant education on the heart.
Chronic pathologies in the stage of decompensation.
A mental illness when contact with the patient is impossible before and after transplantation.
Obesity.

TO absolute contraindications include the abuse of alcohol and smoking, any narcotic substances.

Transplant preparation

Before registering or undergoing surgery, patients must undergo laboratory and instrumental examinations.

The recipient must pass:

Fluorography, radiography of the sternum.
Mammography and cervical smear for women, PSA for men. These analyzes allow to determine oncological pathologies.
Ultrasound, EKG.
Coronary angiography, thanks to which it is possible to assess the condition of the vessels. If necessary, stenting or shunting 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 Rh, general clinical.
Analysis of urine.
Examination by a cardiologist, gynecologist, ENT and, if necessary, other narrow specialists.

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

Who can be a donor

The implanted organ is usually taken from dead people accident, serious injury, or brain death. The ideal graft is one that has not suffered from coronary disease and has no dysfunction.

It is desirable that the donor does not suffer from heart pathologies, and his age is up to 65 years. It is very important that the transplanted organ is the correct size.

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

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

How long to wait for a donor heart

If a patient needs a transplant procedure, they are placed on a waiting list at the transplant center. This institution is in contact with medical organizations where donors may appear.

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

Most people have only 1-2 years to wait, while their condition is supported by medication. As soon as a suitable donor is found, the operation is immediately performed in a planned or emergency mode.

How is waiting for a donor heart?

In the process of waiting and preparation, cardiac pathologies are treated with medication. At chronic insufficiency 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. A special apparatus is connected there to carry out blood flow in bypass ways. It is in this case that the patient can be moved to the top of the waiting list.

Operation types

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

The most common is the orthotopic method.

How is the operation

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

First, the doctor processes the desired surface and makes a longitudinal incision, opens 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 main vessels are left. A donor heart is sutured at this site. Since there are two types of transplantation, depending on the chosen one, the organs are fixed.

In the heterotopic view, the own organ remains in place, and the graft is placed lower to the 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 hypertension of the small circle.

Orthotopic transplantation consists in suturing your own atria to the donor's after the removal of the ventricles. The vena cava can be stitched 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.

Childhood transplant surgery

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

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

When the patient is put on the waiting list, the prognosis of life is disappointing, he has to wait from 1 week to 1.5 years. 20-50% of these people die without waiting for a transplant.

Five-year survival in children is about 45-65%, within one year this figure is slightly higher and is 78%. About 3 years live no more than 72%, 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 when long-term use cyclosporins, coronary atherosclerosis develops faster.

When an operation is performed on a child within six months after birth, the one-year survival rate is no more than 66%. This is due to the mismatch of the vessels.

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

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 apply various means for the correction of the skin in the area of damage. Some do not hide it and are even proud of it.

How long does rehabilitation take

After transplantation, 4 stages of rehabilitation are noted:

The first one is called " resuscitation period”, takes from 7 to 10 days.
The second is called the hospital period, lasts up to 30 days.
The post-hospital period is delayed up to 12 months.
And the fourth phase can take 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 a hemodynamic assessment and immunological control. At the fourth stage, the patient can already return to the usual labor activity, but some controls still remain.

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

Within a few months after discharge, the patient must undergo special examinations 1-2 times a week. medical examinations to check the absence of infection and complications in the operation of the graft.

Basic rules for recovery after surgery

After transplantation, vasoprotectors and cardiotonic drugs are prescribed. Quantity checks are required ionized calcium to see how the heart works. In addition, it is measured acid-base balance are given immunosuppressive therapy to prevent organ rejection.

Immediately after awakening from anesthesia, the patient is disconnected from the apparatus, the number of cardiotonic drugs decreases. To assess the functionality of the transplant, resort to the method of myocardial biopsy.

In addition, there may be:

Tests for the presence of infection.
Radiography of the lungs.
Electrocardiogram.
Echocardiography.
General biochemical analysis blood, as well as checking the performance of the kidneys and liver.
BP control.

Restrictions

In order to exclude serious consequences and complications, as well as to improve the engraftment of the organ, it is necessary to observe a certain lifestyle:

Take the recommended medications: cytostatics and hormones that help weaken your own immunity so that foreign tissues 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 by eliminating harmful foods, such as fatty, fried, smoked.
Protect yourself from infection. Life after the operation 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 passed heat treatment. This is necessary because due to the use of immunosuppressive therapy, one's 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 the daily routine and consume only healthy food without weighing down cardiovascular system harmful products and meals.

Fractional nutrition involves 5-6 meals per day. This helps reduce stress and prevent obesity. Do not allow long intervals between meals.

The diet implies an exception:

Sausages.
High-fat dairy products, including hard cheeses.
Fatty meat.
Smoked meats.
Muffins.
Meat offal.
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 refuse sweet and salty. But if you can’t eat fresh, then it’s better to switch to iodized salt, but not more than 5 g per day. From sweets, you can eat dried fruits.

Products are useful for steaming or boiling. The last meal should take place no later than 2-3 hours before bedtime.

In the diet you need to enter:

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

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

Do they give disability

Usually patients who need a transplant already have a disability of the corresponding group. Depending on how the operation went and how the patient feels after transplantation, medical board considering renewal or transfer to another group.

In this case, there are no precisely regulated rules for establishing a group, therefore everything is decided according to the individual indicators of the patient.

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

Lifespan

After a heart transplant, the survival rate 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, the new heart functions properly for 5 to 7 years, but it is more prone to dystrophy than its own healthy organ.

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

Complications after surgery

by the most severe consequence graft rejection is considered. This may not happen immediately, but after a few months. Early postoperative complications include bleeding and infection.

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

In addition, an oncological disease in the form of lymphoma or myeloma can develop, this is facilitated by immunosuppressants, 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 the operation, 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 the patients develop the disease coronary artery within 1-5 years after the operation.

It is possible to suspect in the postoperative period that something went wrong when:

Chest pain, shortness of breath.
Strong cough.
Puffiness.
Migraines and dizziness on an ongoing basis.
high temperature.
Arrhythmias associated with nausea and vomiting.
Coordination disorders.
Increased or decreased blood pressure, deterioration in general well-being.

Heart transplantation is considered very complicated operation. The main difficulty lies in the lack of a donor organ according to the quota, and half of the patients die without waiting for it.

In addition, even if the patient was operated on in time, organ rejection or wound infection may occur, which can lead to lethal outcome. Nevertheless, transplantation 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 from 1 year to 11 years, and sometimes more.

The surgeon Christian Barnard secured eternal glory for himself by successfully performing what no one before him could do - a heart transplant. Although his no less 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 operation were made as early as the 19th century.

Before Christian Barnard, there were many heart transplant attempts. First famous 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 cardiac expansion was recorded. And after 15 years, doctors began to actively undertake operations that had previously seemed impossible - interventions were carried out to correct anomalies of the vessels located near the heart.

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

By 1953, a device was created that provides the patient with continuous blood circulation. He allowed the American surgeon George Gibbon to perform the first ever corrective surgery. 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 Waskansky by transplanting the heart of a woman who had died shortly before in an accident.

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

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

But by 1970, their number had dropped sharply. The reason for this was the high mortality a few months after the manipulations. It seemed to doctors that transplantations could already be put an end to, since the immune system stubbornly rejected a new heart.

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

Having received world recognition, Christian Barnard took up 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, help people in all corners of the planet:

Thanks to the money raised by the production of environmentally friendly clean products and sale of author's literature, renowned surgeon financially helped cancer clinics.
His other foundation provides material assistance to poor women and children from countries with low level life.

Modern heart transplants

Valery Ivanovich Shumakov - Soviet and Russian transplant doctor, professor

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

But in the world this operation did not become a sensation. Before Shumakov, more than a thousand such operations were performed and with a more successful outcome. The first patient of the surgeon died a few days later - the kidneys could not stand the immunosuppressants.

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

Now advances in science make it possible to do 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 a transplant:

Defects of the heart and blood valves;
Diseases of the coronary arteries;
dilated cardiomyopathy.

And most famous case in the history of cardiology was the case history of the billionaire Rockefeller. His condition made it possible to do something that is unlikely to be repeated by anyone in the coming decades, Rockefeller changed his heart as many as 7 times! Died record holder at the age of 101, for reasons not related to cardiology.

A lot has changed since the first heart transplant in the world. Now transplants are carried out at such a high level that many patients not only live full life, but also participate in marathons 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 since, thousands of human lives have been saved, both adults and children.

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

P ervoy successful transplant the organ that Barnard performed was a kidney transplant in October 1967. Inspired by the successful result and absolutely confident in the successful outcome of more serious transplants, Barnard is looking for a patient who agrees to a heart transplant.

We didn't have to wait long - the 54-year-old Polish emigrant, doomed to inevitable death, Luis Waszkanski, gladly accepts the professor's offer to go down in history and become the first patient with a transplanted heart.

Photo: Barnard and Washkansky

D he had no other chance to survive - his heart muscle was so severely affected. It remained only to wait for a donor heart, and Washkansky received it from a 25-year-old girl, Denis Ann Derval, who died during a severe car accident. The heartbroken father (who lost his wife in this accident) agreed to the transplant.

And now - half past two on the third of December 1967, both operational teams simultaneously begin work. First in the first operating room was removed diseased heart Washkansky, after this, Barnard removes the donor's heart in two minutes and transfers it to the next room. Three more hours of painstaking work on implanting 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 Farican surgeon. But this was not what interested him, but how the patient's body would behave in relation to an organ, albeit vital for him, but still completely alien. After all, the reaction of rejection, which in human body all foreign bodies, both artificial and biological, very often nullifies 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, the 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 caught a severe pneumonia, from which he could not recover. 18 days - exactly how long the first human heart in the history of a transplanted human heart beat.

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

Photo: Barnard with Grace Kelly. August 8, 1968

B arnard considered the Soviet surgeon Vladimir Demikhov (1916-1998) his teacher all his life. Professor Vladimir Onopriev in his book of memoirs “Live according to the mind and conscience” writes:

“I found out what a grateful student Christian Bernard turned out to be. On the eve of that world's first heart transplant operation, he calls Demikhov across half the globe. Arriving (already after the famous operation) once again in Moscow, looking around the ranks of the meeting officials and exclaimed:
“I'm sorry, but I don't see my teacher here, Mr. Demikhov. Where is he?"

The meeting officials looked at each other in bewilderment: who is this? Thank God, someone remembered, they had to get out: Mr. Demikhov did not come because of the extraordinary employment at the Institute of Emergency Medicine named after. Sklifosovsky. The guest immediately expressed a desire to immediately recover to him. I had to lead. In the semi-dark cold basement, where the laboratory of the first department of organ transplantation in the USSR was located, Bernard found his teacher ... "

A story 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 that he said at lectures by heart. Noticing this, Barnard somehow decided to joke and asked the driver to give another lecture instead of him.

That evening, the professor, dressed in the uniform of a driver, sat in the hall among the audience, and his driver made a report and answered various questions from the audience. But there was still one listener who asked him a very tricky question, to which the speaker found it difficult to answer. However, the resourceful "lecturer" did not lose his head. “I beg your pardon, madam,” he replied, “I am already very tired today. And I will ask my driver to answer your question ...