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

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

Story

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

Studies were also carried out to develop methods for preserving the heart, and the acceptable terms for transplant collection and storage were determined (see Preservation of Organs and Tissues). Received in experimental studies the results allowed Shumway et al. (1964) to approximately determine the list of conditions under which P. s can be shown. in patients.

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

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

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

A wide discussion that arose on this issue not only among specialists, but also with the involvement of various sectors of society, formed a public opinion about non-compliance with moral, ethical and legal norms when performing P. s. in a wedge, practice. In addition, in a number of countries, including the USSR, the legislation does not recognize the diagnosis " brain death» for criterion biol, death of an organism giving the right to statement of a question on a possibility of removal of bodies. In these countries at the existing legislation it is really possible to carry out P. with. in patients only after the development of methods for restoring full contractile function a transplant taken from the body of a donor, in which the cessation of heart contractions is registered.

This issue requires further in-depth study. In view of what was stated in the USSR, this operation cannot be used in clinical practice.

At the same time, P. is practiced in a number of countries. The first attempt of clinical P. of page. was undertaken on January 23, 1964 by Amer. cardiac surgeon J. D. Hardy, who replaced the heart of a chimpanzee heart patient. The transplant functioned for one hour. In December 1967, Barnard (S. N. Barnard) performed the first orthotopic heart transplantation from person to person. The patient lived 18 days.

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

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

Indications

The question of formulating accurate and correct indications for P. s. appears to be very difficult. As can be seen from the history of the development of surgery, views on indications for surgery have been formed over the years and change over time depending on the development of honey. science. Basically P. with. in countries where it is allowed, it is carried out by patients in whom any physical activity is accompanied by a feeling of discomfort (according to the New York functional classification heart failure, these patients belong to group IV).

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

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

Thus, P. with. applied in these countries only in the terminal stage heart disease and is relatively urgent.

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

Methodology

At P. with. generally accepted methods of anesthesia used for large cardiac surgery. The operation consists of several stages: taking a heart from a donor, securing the graft myocardium in the pre- and intra-transplant periods, removing the heart (or part of it) of the recipient, and graft suturing.

Heart sampling from a donor can be performed only after a statement of brain death, which is established on the basis of nevrol, research, the presence of an isoelectric line on the EEG, cerebral angiography data, or the nature and volume of brain damage established during surgery.

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

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

Removal of the heart of the recipient is carried out after the inclusion of cardiopulmonary bypass (see); the operation begins with the intersection of the aorta and the pulmonary trunk at the level of the valves. Then they open right atrium along the atrioventricular sulcus, the left atrium is partially cut off. The septum is cut off leaving as much of the tissue as possible. Most surgeons consider necessary removal auricle of both auricles of the recipient due to the possibility of blood clots from them.

Sewing of the graft differs in different surgeons only in sequence and time. The technique of Lower et al. is mainly used. (1961), in which suturing begins with the application of sutures-holders on the atria (see Fig. 1, a), then the left atria and right atria are sequentially anastomosed using a continuous two-row twisting suture (Fig. 1, b). Stitching of the pulmonary trunk and aorta is also performed according to one of the variants of the vascular suture (see), more often with a continuous two-row blanket suture (Fig. 1, c, d). An important point surgery is to prevent air embolism coronary arteries transplant - drainage of the left ventricle, followed by removal of air by puncture of the ventricles and aorta. Restoration of cardiac activity is carried out using electrical defibrillation (see) followed by suturing of the myocardial electrodes of the pacemaker (EX) to the transplant (see Cardiostimulation).

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

Management of the postoperative period

The main thing in the management of the immediate postoperative period is to ensure optimal cardiac output, which is achieved by maintaining a high central venous pressure (due to infusion sufficient quantities liquid), maintaining the contractile function of the transplant (the introduction of isoproterenol and cardiac glycosides), normalizing the rhythm of the transplanted heart with a frequency of at least 100 contractions per 1 minute, controlled by ventilation (see artificial respiration). A feature of the post-transplantation period that determines the outcome of the operation in these patients is the possibility of developing a graft rejection reaction (see Immunological incompatibility) and the need long-term use immunosuppressive substances (see) and agents. Monitor supervision over immunol, a condition of the patient creates an opportunity early diagnosis and timely treatment rejection crisis. The symptoms of acute heart transplant rejection are varied. They are divided into clinical, electrocardiographic, echocardiographic, morphological and immunological. To clinical signs include a decrease in the precordial impulse, an increase in end-diastolic pressure, signs of right ventricular failure, alternating with left ventricular; to electrocardiographic - a decrease in the voltage of the QRS complex, a shift electrical axis hearts to the right, atrial, less often ventricular arrhythmias, blockade of the conduction system of the heart varying degrees; to echocardiographic - an increase in the diameter of the right ventricle and the thickness of the wall of the left ventricle; morphological - dystrophic and necrobiotic changes in muscle fibers, focal lymphohistiocytic infiltrates in the stroma; to immunological - an increase in the level of lymphotoxins, the number of T-lymphocytes, a decrease in the titer of the reaction of inhibition of spontaneous rosette formation.

At P. with., as well as any other body, essential has optimal immunosuppressive therapy, which includes the introduction of steroids, azathioprine, methylprednisolone, antilymphocyte serum (see Immunotherapy). Doses and regimens vary, but azathioprine 200 mg, methylprednisolone 200 mg intravenously immediately prior to surgery, followed by azathioprine 2–3 mg/kg per day are generally used. The introduction of methylprednisolone is gradually limited: one week after the operation and in the next 3 months. reduce to 10 mg every 8 hours. Antilymphocyte serum is administered intravenously immediately after surgery, and then in decreasing dosages for 6-8 weeks. When signs of rejection appear, methyl prednisolone is prescribed at a dose of 1 g daily for 3-4 days. Other medications, including heparin, are given in maintenance doses.

Complications

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

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

To the most dangerous and often occurring complications of the postoperative period at P. of page. include inf. complications, among which the most formidable is pneumonia. Inf. Complications remain one of the main causes of death both in the immediate and long-term after surgery. During the first year after P.'s operation with. the main cause of dysfunction of the graft is, according to Thomas (F. T. Thomas), Lower (1978), atherosclerosis of the coronary arteries. Prevention of its development can be achieved by the introduction of anticoagulants, antiplatelet agents, as well as special diet, poor in fats.

Social and prof. rehabilitation of patients after P. of page. occurs on average after 6 months. In some cases, patients can engage in their prof. activity.

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

V. I. SHUMAKOV

The first of which was successfully carried out 50 years ago by a South African cardiac surgeon, a European by origin, Christian Netling Barnard, have long passed into the category of routine. It seems that since then science has gone far ahead in this direction, and we are about to fall into the era of high-tech and reliable mechanical hearts. Or grow artificial. But is it really so?

Vessel of love and fearlessness

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

Despite the fact that by 1967, when the first transplant operation was performed, mankind had a fairly extensive knowledge of the function of the heart, some people continued to believe that this organ is the focus of high feelings and courage. And even in 1982, the wife of a certain Barney Clark, a former dentist, who was transplanted the world's first artificial heart (Clark had the final stage of heart failure), was very worried that after such an operation her husband would stop feeling love for her.

To date, heart transplantation is the only treatment for most severe cases of heart failure, which, according to some reports, affects about nine million people in Russia alone. However, in the early 1960s heart transplant was considered an unattainable dream. The risk of organ rejection and life-threatening infections was simply prohibitive. Nevertheless, already in the second half of the decade, humanity took its decisive step towards heart transplantation.

heart transplant operation

Transplant "arms race"

The development of cardiology has led to a kind of race - who will be the first to carry out a heart transplant (a sort of "arms race" in cardiac surgery). Four or five surgeons in the world could be called original leaders of the race. But the most daring, lucky and talented was Christian Barnard. The second was American surgeon Norman Edward Shumway who performed the first heart transplant in the history of the United States in 1968. They both held clinical residency at the University of Minnesota, but the relationship between them was cold, for which there were reasons.

Shumway despised Barnard for his "ostentatiousness, provocative demeanor, and willingness to cheat." Dr. Barnard, in turn, was outraged that Norman seemed to see him in the first place. a stranger from a second-class country. In addition, Barnard's status as a specialist was lowered due to the fact that his American counterpart had much more extensive experience in animal heart transplants.

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

By the end of 1967, Dr. Shumway announced that he was going to start a clinical trial at Stanford that would eventually lead him to a human heart transplant. Shumway thought that animal operations must and will continue, however, he declared that he had already approached the border beyond which begins clinical application his experience. It is believed, however, that the American was at a disadvantage because he had difficulty finding donors. human heart.

Dead brain, living heart

Indeed, during this period, American legal regulations prohibited the removal of organs from those patients who had brain death, but the heart was still beating. In order to take the heart, it was necessary that it stop beating completely. Theoretically, the situation could have developed in such a way that a surgeon who would have neglected these rules would have landed in jail for murder.

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

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

Less than a month later, Dr. Shumway performed the first heart transplant in the Americas on January 9, 1968. However, the talented surgeon was forced to settle for only second place. His patient, a 54-year-old steel worker, lived 14 days after the transplant. After the patient passed away, Dr. Shumway acknowledged the presence of, as he himself put it, "a fantastically cosmic number of complications."

How long do people live after a heart transplant?

Mechanical heart or grown?

Nowadays, given the quality medical preparations, which prevent the body of patients from rejecting a foreign organ, the life expectancy of some heart transplant patients is truly amazing.

Approximately 85% of patients live at least a year after such a complex procedure. The average life expectancy after such an operation is from 12 to 14 years if the patient survived the first year after an organ transplant.

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

If we take into account the total number of Americans suffering from heart failure, then, as one Lynn Stevenson, an expert in cardiovascular diseases one of the most prestigious research universities USA - Vanderbilt University, "Heart transplant surgery is as much an answer to heart failure as the lottery is the answer to poverty". It turns out that the hope for development this direction medicine through donor hearts is utopian.

It is for this reason that the most ambitious projects are the plans of scientists to massively replace a diseased human heart with a ready-to-use mechanical device. This is the dream of cardiologists and surgeons. And while functioning mechanical hearts have been introduced to the world since the 1980s, their use is still associated with unforeseen complications. Today, the most reliable mechanical heart is most often a left ventricular assist device that attaches to the patient's heart, pumping blood directly into the aorta.

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

One of the many problems, for example, is that it has not yet been possible to solve the problem of the simultaneous cultivation muscle tissue and the so-called vascular bed through which metabolism takes place. Messages appear here and there within the next 10 years or more, scientists will solve most of the problems. In the meantime, for most patients, the only real hope remains the hope of a donor heart transplant; a hope that half a century ago was given to the world by a pioneer from the heart of South Africa.

Heart transplant in Russia

Do you know that...

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

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

The most successful heart surgery

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

7 human heart transplants!

Record holder for the number of hearts

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

Exactly thirty years ago, on March 12, 1987, the first successful heart transplant was performed in the USSR. It was conducted by the 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 drive blood through the body.

“As I remember now, it was on the night from Friday to Saturday,” Academician Valery Shumakov recalled in an interview with Ogonyok. - They performed an operation, transferred the patient to intensive care, she woke up. And early in the morning a call from the ministry: “What are you doing there?” The answer is that everything went well. A responsible comrade immediately arrived, went into the ward, looked at the patient. Turns around and says, "I need a phone." They gave him a telephone, and he began to call the department of science of the Central Committee of the CPSU. 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, of course, of historical significance,

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

However, the USSR lagged far behind the world practice in transplantation, the reason for this was the legislation and the lack of donor centers. For more than two decades, Shumakov and his associates have sought to recognize the diagnosis of brain death as a sufficient basis for organ removal. By inexplicable terms common sense For reasons, this concept was considered inconsistent with the norms of socialist morality. As a result, a dead end situation arose for transplantation: the liver, heart and lungs must be removed only from a donor with a beating heart, and this is impossible.

Only in 1987, death began to be ascertained according to the diagnosis of "brain death", and literally a few months later Shumakov transplanted his first heart.

In the world, the first such operation 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 outside 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 Christian Barnard came world fame, in South Africa in the late eighties, he became so popular that they began to sell souvenirs with the image of his hands.

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

After all, it was Demikhov who in 1962 carried out the world's first successful heart transplant along with lungs to a dog,

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

However, in the USSR, Demikhov was persecuted, he was not allowed to defend his dissertation and conduct experiments for a long time. 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 the death of a person, he was even able to save a patient with serious blood loss by transfusing the blood of the deceased. These experiments also proved the possibility of transplanting organs from the dead.

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

AT modern world heart transplantation operations are considered ordinary, according to the International Society for Heart and Lung Transplantation, they are performed 3,800 per year, and in Russia - about 150. “This is a big operation, but it is no more complicated than those that are performed today in many clinics. It has been worked out to the smallest detail. The management of the postoperative period is very well known. Complications are known,” says surgeon Leo Bokeria.

There are cases when patients after transplantation live for more than twenty years. Tony Huisman is the world record holder for longest life.

lived for 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.

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

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

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

A 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.

A 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!..

A 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 in South Africa. His driver, a smart and fairly educated guy, sitting in the hall, always listened very carefully to his patron - he knew everything 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 ...

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, ischemic disease heart, arrhythmia, cardiomyopathy and other serious diseases, a heart transplant is only chance for life. There is currently acute shortage heart donors, forcing patients long years be on the waiting list for a transplant.

Indications for surgery

Heart transplantation is mandatory 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. 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. 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. 3. The future donor must not have bad habits, diseases of cardio-vascular system and his age should not exceed 65 years.
4. 4. The main difficulty of transplantation has been and remains histocompatibility, or organ compatibility. You can not transplant a heart from a random person, even with immunosuppressive therapy, as this will cause rejection of the organ. 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 chest patient 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 into 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 of 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 re-operation will be performed at the age of about 70 years. It is obvious that 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.