Who was the first to perform a heart transplant? Heart transplant - what you need to know about such an operation

Unfortunately, not all diseases of the heart and blood vessels can be treated drug therapy. In some cases, the question arises of carrying out such a labor-intensive surgical operation like a heart transplant. However, there are many contraindications to its use, and life expectancy is still not very long.

First experiments

The first heart transplant was performed in the mid-20th century - in 1964 - by James Hardy. He used a Chimpanzee as an organ donor, and the patient lived after that for only 1.5 hours.

The first successful transplant of the main “motor” human body in the world was held a little later - in 1967 by Christian Barnard in Cape Town, South Africa. The recipient was 55-year-old Louis Vashkansky, who suffered incurable disease heart, and the donor was 25-year-old Denise Darval, who died in a car accident. It was believed that the operation was performed perfectly, but the patient died from its complications on the 18th day.

Unfortunately, success early operations was reduced to zero due to the imperfection of technology and equipment for artificial blood circulation, as well as insufficient knowledge in the field of immunology. With development new era cyclosporine in 1983, the survival rate of recipients was significantly increased.

Transplantation of the body's main "pump" has become a routine operation performed in a variety of centers around the world. The only problem a small number remains donor organs, because the heart can be removed only under certain conditions: recorded brain death, absence of pathologies and age under 65 years.

At the current level of development of transplantology, transplantation of the heart and other organs from the body of one biological species to the body of another biological species is not carried out, but scientists do not give up attempts to obtain material for transplants, for example, heart valves, tendons, from xenogeneic tissues of animals, in particular pigs. cartilage

Work continues to change the genome of pigs, which will reduce to zero the risk of rejection of a foreign organ by the human defense system. Japanese scientists are making attempts to grow human organs in the body of pigs and claim that very soon it will be possible to obtain a pancreatic gland from patient skin tissue and successfully treat diabetes.

Who is indicated for surgery?

A heart transplant is indicated if the following pathologies are present on the face:

ejection fraction less than 20%;
atherosclerotic changes in large quantities coronary arteries;
dilatational or hypertrophic form cardiomyopathy;
congenital defects of the main “motor” of the body and valves;
irregular rhythm that cannot be treated;
cardiac ischemia.

When evaluating a transplant candidate, doctors first evaluate heart failure according to the NYHA system. It takes into account symptoms depending on the patient’s level of activity and quality of life.

The operation is indicated for minimal physical activity when even a short walk causes shortness of breath, palpitations and weakness. The same applies to people whose heart failure develops at rest, and any action is fraught with discomfort. The indication for surgery is also a poor prognosis for survival without surgery, which is less than a year.

The patient’s desire and ability to be examined and follow the subsequent treatment plan is taken into account. The recommended age for transplantation should not exceed 65 years.

Contraindications

Heart transplantation is contraindicated in the following cases:

The operation is not performed on people over 65 years of age, but this factor Doctors evaluate individually.
Sustainable pulmonary hypertension, which is characterized by a vascular wall resistance of more than 4 Wood units.
Systemic infections or diseases in active form.
Oncology, but at the same time taking into account predicted survival and tumor type.
Smoking, alcoholism or drug addiction.
Psychosocial instability.
Reluctance and inability to comply with the therapeutic and therapeutic plan diagnostic measures.
Positive test for HIV.
Hepatitis B and C, but this is determined on an individual basis.

How it all happens

It must be said that the process of preparation and examination is quite lengthy and complicated. Everything is taken from the future recipient necessary tests, are examined for infectious and viral diseases, HIV, hepatitis, etc. Conducted instrumental studies And diagnostic procedures with invasion.

While waiting for a donor organ, the patient is constantly monitored and monitored for signs of deterioration in heart function. Preoperative management of the candidate is carried out with the participation of qualified personnel, relatives of the patient and in direct contact with the transplant center.

The examination procedure and potential donors are not neglected. Heart transplantation is possible with good ejection fraction, satisfactory condition of valve structures, and absence of left ventricular enlargement. If the potential recipient is in critical condition

, then he can be transplanted with an “imperfect” heart.

The final verdict on the suitability of the donor organ is made by an experienced surgeon after direct examination of the organ and sternotomy. After surgery, immunosuppressive therapy is carried out, vasopressors and cardiotonics are prescribed. The patient will be required to attend coronary angiography annually.

Many people are interested in how long do people live after such an operation? If you believe the statistics, the life expectancy of such patients ranges from 10 years or more. The world record was broken by Tony Huseman, who lived with a transplanted heart for more than 30 years and died from skin cancer.

The main problem remains organ rejection by one’s own immune system, but when it comes to children, parents, without hesitation, agree to the operation in the hope of a normal future life for their child. To the most possible complications include pneumonia, bleeding and formation blood clots

, damage to organs, such as kidneys, decreased brain performance, cancer. Of course, the recovery period is long and difficult, but is this an obstacle for a person who wants to live? Heart transplantation has become an established treatment for end-stage heart failure. Candidates for heart transplantation are patients conservative therapy in which it is ineffective, while others surgical methods

correction of heart disease is not indicated due to insufficient myocardial function. The key points in heart transplantation are the evaluation and selection of recipients, as well as postoperative management

and immunosuppression. Consistent implementation of these steps in accordance with heart transplant protocols is the key to the success of the operation.

History of heart transplant First successful transplant human heart was made by Christian Barnard in South Africa in 1967. Early research in this area were carried out by scientists in various countries

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

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

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

Diseases for which heart transplants are performed:

Dilated cardiomyopathy – 54%

Ischemic cardiomyopathy with coronary disease hearts - 45%

Congenital heart pathology and other diseases – 1%

Pathophysiology of heart transplantation

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

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

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

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

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

Clinical picture

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

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

New York Heart Association (NYHA) classification of heart failure

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

Indications

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

Specific indications and conditions for heart transplantation

Dilated cardiomyopathy

Ischemic cardiomyopathy

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

Ejection fraction less than 20%

Intractable or malignant arrhythmias when other therapy is ineffective

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

Age less than 65 years

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

Contraindications

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

Survey

Lab tests

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

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

Screening for infectious diseases

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

HIV testing

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

Virological screening

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

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

Tuberculin skin test

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

Serological tests for fungal infections

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

Screening for cancer

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

Prostate-specific antigen (PSA) test

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

Mammography

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

Cervical smear examination

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

Instrumental examinations

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

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

To exclude other organ pathologies chest An X-ray of the chest organs is performed, possibly in two projections.

Pulmonary function tests may be used to assess pulmonary function. Severe uncorrectable chronic lung disease is a contraindication to heart transplantation.

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

Diagnostic invasive procedures

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

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

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

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

Outcome and prognosis

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

Prospects and problems of heart transplantation

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

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

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

Heart transplant in Belarus - European quality at a reasonable price

Just over 100 years ago, the world's leading surgeon, Theodor Billroth, predicted that any doctor who dared to perform surgery on the human heart would immediately lose the respect of his colleagues...
However, back at the end of the 19th century, the first reports of successful attempts at heart surgery appeared, and in 1925, for the first time, it was possible to expand the affected heart valve.
In the most severe cases, the entire heart needs to be replaced, for which a heart transplant is performed... The appeal of this operation, widely publicized in the late 1960s, dimmed significantly when it became clear that it was associated with almost insurmountable problems caused by the rejection of foreign tissue...

Sixties. World sensation: Bernard transplanted a donor heart into a person in distant Cape Town - on the night of December 2-3, 1967. Christian Barnard is a legendary cardiac surgeon from South Africa, whom his colleagues compared... to Gagarin. “The only thing that distinguishes me from Yuri Gagarin is that during his first flight the cosmonaut himself took risks, and during the first heart transplant the patient took risks,” Christian Barnard said many years later.

He admitted to journalists more than once that, having decided to undergo a heart transplant, he did not at all regard this operation as a breakthrough in medicine. Christian Barnard did not film her and did not inform the media about her. Moreover, even the head physician of the clinic where Professor Barnard worked did not know about it. Why? Because it was impossible to predict its outcome. Louis Vashkhansky is the first patient with a heart transplant, in addition to cardiac problems, which in themselves threatened fatal, suffered from diabetes and a whole bunch of concomitant diseases. And although he was only 53 years old, he was doomed to a slow and painful death. Vashkhansky lived with a new heart for 18 days. But it was a breakthrough in transplantology!
In the USSR, the “white racist from a fascist state” was immediately accused of plagiarism and appropriation of the latest techniques. By the way, decades later, Bernard, recognized by the whole world, announced to the whole world that he studied transplantation from the Russian scientist Demikhov, from the one whose lectures Shumakov listened to. By the way, it was Demikhov who was the first in the world to perform an operation with an artificial heart (in an experiment) in 1937. Of course, it’s a shame that the Americans bypassed us, the discoverers.

The official bodies, which were in charge of everyone and everything at that time, do not lift their taboo on heart transplant operations - thank you for at least allowing a kidney transplant.
Therefore, in 1967, secretly from the medical authorities, not in Moscow, but in Leningrad at the Kirov Military Medical Academy, an outstanding surgeon, Muscovite, academician Alexander Aleksandrovich Vishnevsky performed an operation to transplant a donor heart taken from a woman who had been hit by a tram and died. They tried to keep the operation quiet.
In Russia the first successful operation heart transplantation was conducted by Valery Shumakov, director of the Research Institute of Transplantology and Artificial Organs.

According to him, Christian Barnard exactly repeated the operation technique developed by the Americans Lower and Shumway.
“They performed similar operations on animals, but could not decide to operate on a person. But Barnard made up his mind,” said Valery Shumakov. – And I didn’t consider it any special achievement...
Christian Barnard died in 2001 from a heart attack. No one undertook to transplant him a new heart.
On January 28, 2008, the heart of Valery Ivanovich Shumakov, a doctor who saved the hearts of others, stopped from acute heart failure...

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Topic5

1, what legal documents transplantation is regulated in Russia STR 74

To provide legal framework Clinical transplantology in most countries of the world, on the basis of humanistic principles proclaimed by the world community, appropriate laws on organ and tissue transplantation have been adopted. These laws stipulate the rights of donors and recipients, restrictions on organ transplantation, and the responsibilities of health care institutions and medical personnel. The main provisions of the current laws on organ transplantation are as follows:

1. Organ transplantation can only be used if other means cannot guarantee the life of the recipient.

2. Human organs cannot be the subject of purchase and sale. These actions or their advertising entail criminal liability.

3. Removal of organs is not permitted if they belong to a person suffering from a disease that poses a threat to the life of the recipient.

4. Removal of organs from a living donor is permitted only if the donor is over 18 years of age and is in a genetic relationship with the recipient.

5. Collection of human organs is permitted only in government institutions healthcare. Employees of these institutions are prohibited from disclosing information about the donor and recipient.

6. Removal of organs from a corpse is not allowed if the health care institution at the time of removal was informed that during life this person, either his close relatives or his legal representative expressed their disagreement with the removal of his organs after death for transplantation to another person.

7. A conclusion about a person’s death is given on the basis of brain death. Legal and ethical regulation of human organ and tissue transplantation mechanisms is one of the most important areas of modern bioethics, promoting the adoption of international and national legal acts and documents. In 2001, the Council of Europe adopted a document known as the Additional Protocol to the Convention on Human Rights and Biomedicine concerning the transplantation of human organs and tissues. According to this document, a necessary condition for organ transplantation from a living donor is the existence of a close relationship between the recipient and the donor. Determining exactly which relationships should be considered “close” is within the competence of national legislation.

According to current Law of the Republic of Belarus “On transplantation of human organs and tissues” (1997), only a person who is genetically related to the recipient can act as a living donor. In addition, a person who has not reached the age of majority cannot be a donor.

The upcoming new version of the Law (Articles 8-9) introduces a transition to any type of connection between a living donor and a recipient, not only genetic. With the new broad approach, there is a danger that a living donor organ will go to any recipient, perhaps not even from the waiting list. Especially a lot of controversy arises regarding how the consent of a potential donor or his relatives to the removal of organs for transplantation should be established.

different countries There are various consent procedures. One of them is based on the so-called presumption of disagreement. In this case, a necessary condition for the use of the deceased’s organs is the person’s express prior consent that after death his organs and tissues can be used for transplantation. Such consent is recorded either in the person’s driver’s license or in a special document - the donor’s card. In addition, appropriate permission can be obtained from the relatives of the deceased.

In the second case, the decision to remove the deceased's organs is based on the presumption of consent. If a person has not explicitly objected to the posthumous removal of his organs and if his relatives do not express such objections, then these conditions are accepted as the basis for considering the person and his relatives to agree to organ donation. This is exactly the norm that operates in domestic legislation (Article 10 of the Law on Transplantation).

In general, experience shows that in countries where a presumption of consent is accepted, obtaining donor organs is easier compared to countries that rely on a presumption of disagreement. However, the disadvantage of a system based on a presumption of consent is that people who are unaware of the existence of such a norm automatically fall into the category of consenters.

To avoid this, in some countries the refusal to act as a donor is recorded in a special document - a “non-donor card”, which a person must carry with him at all times. In Belarus, such mechanisms are not provided. The uncertainty of the situation arising in connection with this is as follows. On the one hand, since the law does not oblige doctors to establish contact with the relatives of the deceased and find out their opinion regarding the removal of organs (although the Law gives them such a right), then in fact the relatives are not given the opportunity to take part in resolving the issue. On the other hand, the doctors themselves find themselves in a vulnerable position: after all, relatives who find out about the removal of the deceased’s organs after it has happened may well go to court. Due to their own insecurity, doctors are often not inclined to engage in the rather complex procedures required to remove organs, reasoning something like this: why take on any additional responsibilities, if you can get yourself into serious trouble?

According to many doctors, it is optimal to introduce a system of requested consent, which will create a data bank on potential donors and facilitate the possibility of earlier obtaining information for the optimal selection of donor-recipient pairs. In addition, the introduction of such a system will facilitate the integration of the domestic transplant service into international organizations on the exchange of information, organs and tissues, which will increase the likelihood of receiving a transplant that meets medical criteria.

As noted by ethicist I. Siluyanova, Doctor of Philosophy, Professor of the Russian State medical university, “the doctor’s action - either on the basis of presumed (“unsolicited”) consent, or on the basis of accepting such ideas as “death serves to prolong life”, “health at any cost” as guiding and all-justifying ideas, cannot be assessed as ethical. Without the voluntary lifetime consent of the donor, the idea “death serves to prolong life” turns out to be just a demagogic judgment. The prolongation of a person’s life is served by the conscious, and not the assumed, will of another person to save human life.

A sign of a developed, primarily morally, society is the readiness of people to sacrificially save lives, a person’s ability to consciously, informed and freely consent to donation, which in this form becomes “a manifestation of love that extends beyond death.” Neglecting free consent, saving the life of one person at any cost - as a rule, the cost of the life of another person, including through the refusal of life-sustaining procedures - is ethically unacceptable.”

Orthodox Church in "Fundamentals" social concept Russian Orthodox Church”, adopted at the bishops’ council of the Russian Orthodox Church on August 15, 2000, stated its unequivocal position: “The voluntary lifetime consent of the donor is a condition for the legality and moral acceptability of explantation.

If the will of a potential donor is unknown to doctors, they must find out the will of the dying or deceased person, contacting his relatives if necessary. The church considers the so-called presumption of consent of a potential donor to the removal of organs and tissues, enshrined in the legislation of a number of countries, to be an unacceptable violation of human freedom.”

For comparison, let's look at some concepts of legislation on organ and tissue transplantation in the CIS countries and non-CIS countries. The federal law Russian Federation The 1992 Law on Transplantation of Human Organs and Tissues established the “presumption of consent” or the concept of unsolicited consent. Only the reluctance expressed during life to transplant organs and tissues is taken into account.

In the Russian Federation, since 1990, as of 2005, 5,000 kidney transplants, 108 heart transplants, and 148 liver transplants have been performed. Currently, there are 45 transplant centers in Russia, of which 38 perform kidney transplants, 7 liver transplants, 6 heart transplants, 5 lung transplants, 4 pancreas transplants, 3 endocrine gland, in 2 - multi-organ transplantation. In the Russian Federation, the population's need for kidney transplantation is about 5,000 transplants per year, but only 500 transplants are performed.

Question 2. Who performed the world's first successful human heart transplant?

On December 3, 1967, sensational news spread around the world - for the first time in the history of mankind, a successful heart transplant was performed on a person! The owner of the heart of a young woman, Denise Darval, who died in a car accident, was a resident of the South African city of Cape Town, Louis Vashkansky. A remarkable operation was performed by the surgeon Professor Claude Bernard. People all over the planet watched with excitement the outcome of a bold, dramatic, risky experiment. From the pages of newspapers there were always reports about the state of health of a man, in whose chest someone else’s heart was beating, the heart of a woman. For 17 days and nights, doctors at Cape Town's Hrote Schur Hospital carefully and persistently maintained this beating. Everyone passionately wanted to believe that a miracle had happened! But miracles, alas, do not happen - Vashkansky died. And this was, of course, both unexpected and inevitable. L. Vashkansky was a seriously ill man. In addition to advanced heart disease, he also suffered from diabetes, which always complicates any surgery. The most difficult and major surgery Vashkansky tolerated it well. But it was necessary to prevent the rejection of someone else's heart, and the patient received large doses immunosuppressive drugs: immuran, prednisolone, in addition, he was also irradiated with cobalt. The weakened body was oversaturated with drugs that suppress the immune system, and its resistance to infections sharply decreased. Bilateral pneumonia flared up, “developing against the background destructive changes bone marrow and diabetes." And then the first signs of a rejection reaction appeared. Vashkansky died. Professor Bernard soberly assessed the situation, realized that the death was not caused by his mistakes or technical errors, and on January 2, 1968 he performed a second heart transplant, this time patient Bleiberg. The second transplantation was more successful: for almost two years a foreign heart beat in F. Bleiberg’s chest, transplanted into him by the skillful hands of a surgeon.

In modern transplantology, heart transplantation is a routine operation, patients live more than 10 years. The world record for longest life with a transplanted heart is held by Tony Huseman - he lived with a transplanted heart for more than 30 years and died of skin cancer. The main problem for these patients is transplanted organ rejection immune system. Transfer artificial heart or animal hearts are not as successful as human heart transplants.

studopedia.ru

At serious illnesses hearts, when other operations are impossible or extremely risky, and life expectancy without surgery is short, they resort to heart transplantation. This now common operation has a long and exciting history...

1. In 1937, a third-year student at Moscow University, Vladimir Demikhov, designed an artificial heart and implanted it into a dog. The dog lived with this heart for two hours. Then Vladimir Petrovich experimented for many years and wrote books published in New York, Berlin, Madrid. The wonderful scientist Demikhov is known all over the world. Not in our country - in the USSR, heart transplant experiments were recognized as incompatible with communist morality.

2. The very first heart transplant in the world was performed by the Soviet scientist Nikolai Petrovich Sinitsyn in the victorious year of 1945. He successfully transplanted a frog's heart into another frog. This was the necessary first step from which the long road to human heart transplants began.

3. In 1964, a 68-year-old patient in critical condition was brought to the University of Mississippi clinic in the USA. The head of the department of surgery, James Hardy, decided to take a desperate step - a heart transplant. But in a hurry, a donor heart was not found and the heart of a chimpanzee named Bino was transplanted into the sick one. The operation went brilliantly, but the new heart failed - it turned out to be too small to supply blood to the human body. An hour and a half later, this heart stopped.

4. On December 3, 1967, at Groote Schuur Hospital in Cape Town, Professor Christian Barnard successfully transplanted the heart of a woman fatally injured in a car accident into 55-year-old businessman Louis Washkansky.

5. After the operation, Professor Barnard was asked the question: “Can a jeep engine hum as well as a Volkswagen Beetle engine?” The car analogy seemed apt: despite diabetes and bad habits Louis Washkansky was a man of strong physique, the deceased Dennis Derval was a fragile twenty-five-year-old girl.

6. But the problem turned out not to be power: after the operation, Vashkansky lived for eighteen days and died of pneumonia. The body could not cope with the infection because the immune system was deliberately weakened with special medications - immunosuppressants. It is impossible otherwise - rejection reactions begin.

7. Barnard's second patient lived with a heart transplant for nineteen months. Now people with transplanted hearts not only live happily ever after, but also run marathons, as Englishman Brian Price did in 1985.

8. The world record for life expectancy with a transplanted heart is held by American Tony Huseman: he lived with a transplanted heart for 32 years and died from a disease not related to the cardiovascular system.

9. Surgeon Christian Barnard achieved real fame. He was so popular in South Africa that in the eighties of the last century they even started selling a bronze souvenir - a copy of his golden hands. In a cruel twist of fate, the heart surgeon died of a heart attack. And until his death he considered the Russian scientist Demikhov his teacher.

10. American scientist D. Gaidushek calls organ transplantation a civilized method of cannibalism.

scientificrussia.ru

Historical reference

The first heart transplant was performed in 1964 by James Hardy. The patient received the heart of a chimpanzee. After this, it was possible to keep the patient alive for only an hour and a half.

A significant milestone in successful transplantology is considered to be the transplantation of a human donor heart, performed in South Africa in 1967 by Christian Bernard. The donor was a young woman, 25 years old, who died in an accident. And the recipient is a sick 55-year-old man who has no chance of further treatment. Despite the skill of the surgeon, the patient died of bilateral pneumonia 18 days later.

What is an artificial heart?

Through the joint efforts of cardiac surgeons and engineers, mechanisms called “artificial hearts” have been developed. They are divided into 2 groups:

heme oxygenators - providing oxygen saturation during operation of a special pump for pumping blood from the venous system to the arterial system, they are called machines for artificial circulation and are widely used for open-heart surgery;
cardiac prostheses are technical mechanisms for implanting and replacing the work of the heart muscle; they must correspond to the parameters of activity that ensures a sufficient quality of human life.

The era of artificial heart development began in 1937 with the work of the Soviet scientist V. Demikhov. He experimented with connecting a dog's blood circulation to a plastic pump of his own design. She lived for 2.5 hours. Christian Bernard considered V. Demikhov his teacher.

20 years later, American scientists W. Kolf and T. Akutsu developed the first device made of polyvinyl chloride with four valves.

In 1969, the first two-stage operation was performed: first, the patient was supported by a machine for artificial blood circulation for 64 hours, then a donor heart was transplanted. Until now, the main use of an artificial heart remains a temporary replacement of natural circulation.

Work on complete analogues complicated by the large mass of the device, the need for frequent recharging, high cost similar operation.

Who is a transplant indicated for?

Candidates for a heart transplant are patients with pathology that does not allow them to predict more than a year of life using other treatment methods. These include patients with:

pronounced signs of heart failure with the slightest movements, at rest, if the ejection fraction at ultrasound examination below 20%;
dilated and ischemic cardiomyopathy;
malignant arrhythmias;
congenital heart defects.

Previously existing age restrictions (up to 65 years) are currently not considered decisive. For a child, the timing of the operation is determined by the most optimal preparation, the ability to provide complete immune protection.

Contraindications for surgery

IN medical institutions where heart transplantation is performed, all candidates are included in the “Waiting List”. Patients are refused if:

pulmonary hypertension;
systemic diseases (collagenosis, vasculitis);
chronic infectious diseases(tuberculosis, viral hepatitis, brucellosis);
HIV infection;
malignant formation;
alcoholism, tobacco, drug addiction;
unstable mental state.

What examination is performed before surgery?

The training program includes a list of clinical examinations. Some of them are invasive in nature, involving the insertion of a catheter into the heart and large vessels. Therefore, they are carried out in stationary conditions.

Standard lab tests, allowing you to monitor kidney and liver function and eliminate inflammation.
Mandatory examinations for infectious diseases(tuberculosis, HIV, viruses, fungi).
Studies for hidden oncological diseases (PSA markers for prostate tumors, cervical smear cytology and mammography in women).

Instrumental types of research are determined by the doctor, these include:

echocardiography,
coronary angiography,
radiography,
determination of respiratory functions;
the indicator of maximum oxygen consumption makes it possible to determine the level of heart failure, the degree of tissue hypoxia, and predict survival after surgery;
endomyocardial biopsy of myocardial cells is prescribed if a systemic disease is suspected.

A special study by introducing a catheter into the cavity of the right atrium and ventricle determines the possibility of vascular changes, and measures the resistance in the pulmonary vessels.

The indicator is recorded in Wood units:

if more than 4, heart transplant is contraindicated, changes in the lungs are irreversible;
if the value is 2–4, additional tests with vasodilators and cardiotonics are prescribed to determine the reversibility of increased vascular resistance; if the changes confirm a reversible nature, then it remains high risk complications.

The patient is familiarized with all identified risks before obtaining written consent for the operation.

Progress and technique of the operation

Under general anesthesia the patient's sternum is dissected, the pericardial cavity is opened, connected to artificial circulation.

Experience has shown that the donor heart requires “adjustments”:

the opening between the atria and ventricles is examined, and if it is not fully opened, suturing is performed;
strengthen the tricuspid valves with a ring to reduce the risk of exacerbation of pulmonary hypertension, overload of the right side of the heart and prevent the occurrence of failure (occurs in half of patients 5 years after transplantation).

The ventricles of the recipient's heart, atria and large vessels remain in place.

There are 2 methods of transplant placement:

Heterotopic - it is called a “double heart”, indeed, it is not removed from the patient, but the graft is placed nearby, a position is selected that allows the chambers to be connected to the vessels. In case of rejection, the donor's heart may be removed. Negative consequences method - compression of the lungs and a new heart, creation favorable conditions for the formation of wall thrombi.
Orthotopic - the donor heart completely replaces the removed diseased organ.

The transplanted organ can start working on its own when connected to the bloodstream. In some cases, electric shock is used to start.

The sternum is secured with special staples (it will heal after 1.5 months), and sutures are placed on the skin.

Different clinics use modified surgical techniques. Their goal is to reduce trauma to organs and blood vessels, prevent increased pressure in the lungs and thrombosis.

What is done after a heart transplant?

The patient is transferred to the intensive care unit or intensive care unit. Here a heart monitor is connected to it to monitor the rhythm.

Artificial respiration is maintained until full recovery independent.

Controlled arterial pressure, outflow of urine.
Narcotic analgesics are indicated for pain relief.
For the purpose of prevention congestive pneumonia the patient needs forced breathing movements, antibiotics are prescribed.
Anticoagulants are indicated to prevent thrombosis.
Depending on the electrolyte composition of the blood, potassium and magnesium preparations are prescribed.
Using an alkaline solution, a normal acid-base balance is maintained.

What complications can follow after transplantation?

Most known complications well studied by clinicians, therefore they are recognized by early stages. These include:

addition of infection;
rejection reaction to transplanted heart tissues;
narrowing of the coronary arteries, signs of ischemia;
congestion in the lungs and lower lobe pneumonia;
blood clot formation;
arrhythmias;
postoperative bleeding;
dysfunction of the brain;
damage may occur due to temporary ischemia different organs(kidneys, liver).

How is rehabilitation of a postoperative patient carried out?

Rehabilitation begins with restoration of pulmonary ventilation.

The patient is advised to exercise breathing exercises several times a day, inflate the balloon.
To prevent thrombosis of the veins of the legs, massage and passive movements in the ankles, bending the knees alternately, are performed.
The most complete complex rehabilitation measures the patient can receive it in a special center or sanatorium. Referral should be discussed with your doctor.
It is not recommended to quickly increase the load on the heart.
Hot baths are excluded. You can use a warm shower for washing.

All medications prescribed by a doctor must be taken in the correct dosage.

What examinations are prescribed in the postoperative period?

The function of the new heart is assessed based on electrocardiography. In this case, there is automaticity in pure form, independent of the action of the recipient's nerve trunks.

The doctor prescribes an endomyocardial biopsy, first every 2 weeks, then less often. In this manner:

the survival rate of a foreign organ is checked;
detect the development of a rejection reaction;
select the dosage of drugs.

The need for coronary angiography is decided individually.

Forecast
It is still difficult to carry out an accurate analysis and find out how long operated patients live due to the relatively short period since the introduction of heart transplantation into practice.

According to averages:

88% remain alive within a year;
after 5 years - 72%;
after 10 years - 50%;
16% of those operated on are alive for 20 years.

The record holder is the American Tony Husman, who lived for more than 30 years and died of cancer.

Surgical treatment of heart disease using transplantation techniques is limited to the search for donors and is unpopular among people young obtaining a lifetime permit for organ transplantation. It is possible to create a heart from artificial materials, growing it from stem cells will solve many subjective problems and expand the use of the method.

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. For reasons inexplicable from the point of view of common sense, this concept was considered inconsistent with 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 visited him in the Soviet Union twice, and also called him on the eve of the operation to get recommendations.

After all, it was Demikhov who in 1962 carried out the first in the world successful transplant hearts together with the lungs of a dog,

which became a worldwide sensation and subsequently allowed people to carry out similar operations. Monograph “Transplantation of vital important organs in experiment,” 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. Maintaining postoperative period 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 operation to transplant a human organ grown from stem cells, the trachea, was performed. Professor Martin Birchall, who helped grow it, says that within twenty years, using this technology, people will learn to create almost all transplantable organs.

Among various organ transplants, heart transplantation is second only to kidney transplantation in terms of frequency of operations. It became possible to use such operations more often in practice thanks to the improvement of methods of organ preservation, the technique of artificial blood circulation, suppression with the help of modern drugs rejection reactions. Heart transplantation is performed in the thermal stage of chronic cardiomyopathy with severe heart failure, severe combined

First experiments

The first heart transplant to a dog's neck was performed in 1905. In this case, the heart vessels were connected to the ends and In the future, heart transplantation was also used in the pleural region, on the thigh, and so on. In 1941 N.P. Sinitsyn performed the world's first additional transplantation. In 1961, an orthotopic transplantation technique was developed. The heart was removed at the level of the atria, and then to the remaining walls of the atria and interatrial septum the donor heart was sutured, after which the roots of the aorta of the donor heart and pulmonary artery were anastomosed (connected) to the vascular trunks.

First clinical heart transplant

In 1964, a heart surgeon from America named James Hardy transplanted a monkey's heart into a man who was dying of a myocardial infarction. However, the organ stopped working after 90 minutes. And in 1967, another doctor performed the first clinical heart allotransplantation (human-to-human transplant), but the patient died 17 days later. After this, doctors from foreign clinics began to carry out such transplants en masse, but the results were often unsatisfactory. Therefore, heart transplantation soon became less and less common. This was also connected with moral and ethical aspects. The most successful heart transplant was performed in a clinic in (USA). Currently, this and other large clinics continue to intensively study various nuances of heart transplantation, including searching for methods of maintaining the viability of an organ that has already stopped and restoring it contractile function. Research is also being carried out in the field of creating an artificial heart.

Heart transplant in Russia

Due to frequent rejection in our country, until the eighties of the last century, heart transplantation was practically not performed. But after the invention of the drug Cyclosporine in 1980, which prevents the rejection of a transplanted organ, heart transplantation has become quite widely used in national medicine. Thus, the first successful transplantation was performed by surgeon V. Shumakov in 1987. Now science has gone far ahead, and the operation, fantastic for that time, has become commonplace today. Not so long ago, a heart transplant required stopping it and connecting it to artificial circulation, but now the entire process is carried out with the heart beating.