First successful heart transplant. How is a heart transplant performed?

Unfortunately, not all diseases of the heart and blood vessels are amenable to drug therapy. In some cases, the question arises of carrying out such a laborious surgical operation as a heart transplant. However, there are many contraindications to its use, and life expectancy is still not too long.

First experiences

The first heart transplant was carried out already in the middle of the 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, in South Africa. The recipient was 55-year-old Louis Washkansky, who suffered from incurable disease hearts, 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 the success early operations was reduced to zero due to the imperfection of technology and equipment for cardiopulmonary bypass, as well as insufficient knowledge in the field of immunology. With development new era cyclosporine in 1983, the survival rate of recipients was significantly improved.

Transplantation of the main "pump" of the body has become a routine operation, carried out in various centers around the world. The only problem there remains a small number of 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 transplantation, transplantation of the heart and other organs from the body of one biological species into the body of another biological species is not performed, but scientists do not abandon attempts to obtain material for transplants from xenogenic animal tissues, in particular pigs, for example, heart valves, tendons, cartilage

Work continues to change the genome of pigs, which will reduce the risk of rejection to zero protective system human foreign body. 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 the patient's skin tissue and successfully treat diabetes.

Who is eligible for surgery

A heart transplant is indicated if the face has the following pathologies:

ejection fraction less than 20%;
atherosclerotic changes in in large numbers coronary arteries;
dilated or hypertrophic form cardiomyopathy;
congenital malformations of the main "motor" of the body and valves;
irregular rhythm that cannot be treated;
cardiac ischemia.

When examining a candidate for a transplant, doctors first of all give an assessment of heart failure according to the NYHA system. It takes into account the symptoms, depending on the level of activity of the patient and the quality of his life.

Operation shown at minimum physical activity when even a short walk causes shortness of breath, palpitations and weakness. The same applies to people in whom heart failure develops at rest, and any action is fraught with discomfort. An indication for surgical intervention is also a poor prognosis of survival without surgery, which is less than a year.

The desire and ability of the patient to be examined and follow the plan for subsequent treatment are 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 persons over 65 years of age, but this factor doctors evaluate individually.
sustainable pulmonary hypertension, which is characterized by a resistance of the walls of blood vessels of more than 4 units according to Wood.
Systemic infections or diseases in an active form.
Oncology, but at the same time take into account the predicted survival and type of tumor.
Smoking, alcoholism or drug addiction.
Psychosocial instability.
Unwillingness and inability to comply with the plan of therapeutic and diagnostic measures.
Positive HIV test.
Hepatitis B and C, but this is determined on an individual basis.

How it all goes

I must say that the process of preparation and examination is quite long and complicated. Everything is taken from the future recipient necessary tests, examined for infectious and viral diseases, HIV, hepatitis, etc. instrumental research And diagnostic procedures with invasion.

During the waiting period donor organ the patient is constantly observed and monitored for signs of deterioration in the work of the heart. 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.

Do not neglect the examination procedure and potential donors. Heart transplantation is possible with a good ejection fraction, a satisfactory condition of the valvular structures, and the absence of an increase in the left ventricle. 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 a direct examination of the organ and sternotomy. After graduation surgical intervention immunosuppressive therapy is carried out, vasopressors and cardiotonic drugs are prescribed. The patient will have to report annually for coronary angiography.

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

The main problem remains the rejection of the organ by its own immunity, but when we are talking about children, then the parents, without hesitation, agree to the operation in the hope of a normal later life your child.

To the most possible complications include pneumonia, bleeding, and blood clots, damage to organs, such as kidneys, decreased brain function, cancer. Of course, the recovery period is long and difficult, but is this an obstacle for a person who wants to live?

A heart transplant (transplantation) is not just a replacement of the patient's own organ with an analogue from a deceased donor. This is a system of measures that ensure the survival and functioning of a healthy heart. The need for surgery is dictated by ineffective long-term treatment, the confidence of doctors in a close fatal outcome due to human cardiac pathology.

Historical reference

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

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

The main problem of survival is the degree of rejection of the donor organ by the human immune system. Currently, many specialized cardiological centers own operational equipment.

What is an artificial heart?

Through the joint efforts of cardiac surgeons and engineers, mechanisms have been developed that have received the name "artificial heart". They are divided into 2 groups:

hemo-oxygenators- providing oxygen saturation during operation of a special pump for pumping blood from venous system into the arterial, they are called heart-lung machines and are widely used for open heart operations;
cardioprostheses are technical mechanisms for implantation and replacement of the work of the heart muscle, they must correspond to the parameters of activity that ensure a sufficient quality of human life.

Currently, technical devices continue to improve, before being put into practice, they must withstand animal experiments and undergo clinical trials.

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

After 20 years, American scientists V. Kolf and T. Akutsu developed the first PVC apparatus with four valves.

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

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

Who is eligible for a transplant?

Candidates for heart transplantation are patients with a pathology that does not allow predicting more than a year of life when using other methods of treatment. These include patients with:

severe signs of heart failure at the slightest movement, at rest, if the ejection fraction during ultrasound is below 20%;
dilated and ischemic cardiomyopathy;
malignant arrhythmias;
congenital heart defects.

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

This baby needs urgent surgery to save his life.

Contraindications for the operation

IN medical institutions where a heart transplant is performed, all candidates are put on the "Waiting List". Refuse patients in the presence of:

pulmonary hypertension;
systemic diseases (collagenosis, vasculitis);
chronic infectious diseases (tuberculosis, viral hepatitis, brucellosis);
HIV infection;
malignant education;
alcoholism, dependence on tobacco, drugs;
unstable mental state.

An assessment is made of the patient's ability and desire to maintain a further therapy plan and follow the doctor's instructions for examination and regimen. If the nature of the patient makes contact with the attending physician unlikely, then it is not worth spending the efforts of doctors and the cost of a donor heart on it.

What examination is carried out before the operation?

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

Standard lab tests, allowing to control the function of the kidneys, liver, eliminate inflammation.
Mandatory examinations for infectious diseases (tuberculosis, HIV, viruses, fungi).
Research on 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 allows you to set the level of heart failure, the degree of tissue hypoxia, to predict survival after surgery;
Endomyocardial biopsy of myocardial cells is indicated for suspected systemic disease.

A special study using the introduction of a catheter into the cavity of the right atrium and ventricle establishes the possibility vascular changes, measure the resistance in the pulmonary vessels.

The indicator is taken into account in Wood units:

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

All clarified risks are introduced to the patient before obtaining written consent for the operation.

The course and technique of the operation

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

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

inspect the hole between the atria and ventricles, 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 heart and prevent the occurrence of insufficiency (5 years after transplantation occurs in half of patients).

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

Donor's implantable heart is sutured to the patient's own remains

Two methods of graft placement are used:

heterotopic- it is called a “double heart”, indeed, it is not removed from the patient, but the graft is placed nearby, a position is chosen 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 the new heart, creating favorable conditions for the formation of parietal blood clots.
Orthotopic - a 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.

A temporary pacemaker is placed to support and control the rhythm. IN chest cavity drainage tubes are placed to drain accumulated blood and fluid.

The sternum is fixed with special staples (it will grow together after 1.5 months), and the skin is sutured.

Different clinics use modified surgical techniques. Their goal is to reduce trauma to organs and blood vessels, to prevent an increase in 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. Here, a heart monitor is connected to it to control the rhythm.

Artificial respiration is maintained until full recovery independent.

If the patient's own volume of breathing is sufficient, the endotracheal tube is removed, but oxygen is constantly supplied through a mask or nasal catheters

Controlled blood pressure, urine outflow.
For pain relief, narcotic analgesics are indicated.
In order to prevent congestive pneumonia, the patient needs forced respiratory movements antibiotics are prescribed.
Anticoagulants are indicated to prevent thrombus formation.
Depending on the electrolyte composition of the blood, potassium and magnesium preparations are prescribed.
By using alkaline solution supported normal acid-base balance.

What complications can follow after a transplant?

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

joining the infection;
rejection reaction to the tissues of the transplanted heart;
narrowing of the coronary arteries, signs of ischemia;
congestion in the lungs and lower lobe pneumonia;
thrombus formation;
arrhythmias;
postoperative bleeding;
dysfunction of the brain;
damage due to temporary ischemia various organs(kidney, liver).

To suppress the rejection of donor tissues, the patient is prescribed strong drugs that affect immune cells blood. This simultaneously creates favorable conditions for infection with any infection and cancerous degeneration.

How is the rehabilitation of the postoperative patient carried out?

Rehabilitation begins with the restoration of ventilation of the lungs.

The patient is advised to 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 in turn are carried out.
Most full complex rehabilitation activities the patient can receive 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 to wash.

All drugs prescribed by a doctor must be taken in the right dosage.

What examinations are prescribed in the postoperative period?

The function of the new heart is assessed on the basis of electrocardiography. In this case, there is an automatic pure form, independent of the action of the nerve trunks of the recipient.

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

the survival of a foreign organ is checked;
reveal the development of a rejection reaction;
choose the dosage of drugs.

The question of the need for coronary angiography is decided individually.

Forecast
Conduct precise analysis However, it is still difficult to find out how long operated patients live because of 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%;
20 years are alive 16% operated.

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

Surgical treatment of heart disease by transplantation is limited to the search for donors, unpopularity among people young age obtaining a lifetime permit for the transplantation of their organs. 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.

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

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

Information about the first transplants

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

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

The drug allowed to increase the chances of patients by improving the survival rate of the donor heart.

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

What is the procedure

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

Ventricular failure may develop with birth defect heart, a defect in one of the ventricles or valves.

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

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

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

Indications for surgery

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

In addition, the indications for transplantation are as follows:

dilated cardiomyopathy.
Ischemic disease, myocardial dystrophy in serious condition.
Development benign tumor in the organ area.
Significant rhythm disturbances that do not respond to medical therapy.
Anomaly of the heart of a congenital nature, which are not removed with the help of plastics.

Contraindications

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

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

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

Transplant preparation

Before registering or undergoing surgery, patients in without fail undergo laboratory and instrumental examinations.

The recipient must pass:

Fluorography, radiography of the sternum.
Mammography and cervical smear for women, PSA for men. These analyzes allow to determine oncological pathologies.
Ultrasound, EKG.
Coronary angiography, thanks to which it is possible to assess the condition of the vessels. If necessary, stenting or shunting is performed.
catheterization right side heart, when the pressure in the vessels of the pulmonary circulation is determined.
Taking blood tests for hepatitis, syphilis, HIV, coagulation, group and Rh, general clinical.
Analysis of urine.
Examination by a cardiologist, gynecologist, ENT and, if necessary, other narrow specialists.

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

Who can be a donor

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

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

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

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

How long to wait for a donor heart

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

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

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

How is waiting for a donor heart?

In the process of waiting and preparation, cardiac pathologies are treated with medication. At chronic insufficiency beta-blockers, glycosides, diuretics, ACE inhibitors and calcium antagonists.

If the patient gets worse, he is taken to the transplant center for cardiac surgery. A special apparatus is connected there to carry out blood flow in bypass ways. It is in this case that the patient can be moved to the top of the waiting list.

Operation types

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

The most common is the orthotopic method.

How is the operation

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

First, the doctor processes the desired surface and makes a longitudinal incision, the chest is opened. The patient is connected to a heart-lung machine through the vena cava.

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

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

Orthotopic transplantation consists in suturing your own atria to the donor's after the removal of the ventricles. The vena cava can be stitched separately, this will reduce the load on the right ventricle.

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

Childhood transplant surgery

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

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

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

Five-year survival in children is about 45-65%, within one year this figure is slightly higher and is 78%. About 3 years live no more than 72%, and only 25% live longer than 11 years after transplantation.

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

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

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

Scar after transplant

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

How long does rehabilitation take

After transplantation, 4 stages of rehabilitation are noted:

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

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

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

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

Basic rules for recovery after surgery

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

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

In addition, there may be:

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

Restrictions

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

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

The benefits of proper nutrition

After transplantation, it is important to stick to the daily routine and consume only healthy food without weighing down cardiovascular system harmful products and meals.

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

The diet implies an exception:

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

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

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

In the diet you need to enter:

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

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

Do they give disability

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

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

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

Lifespan

After a heart transplant, the survival rate after 1 year is 85%. Subsequently, rejection occurs in some patients, changes due to infectious diseases, and the percentage drops to 73.

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

Basically, the new heart functions properly for 5 to 7 years, but it is more prone to dystrophy than its own healthy organ.

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

Complications after surgery

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

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

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

In addition, after the operation, you may experience:

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

Half of the patients develop the disease coronary artery within 1-5 years after the operation.

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

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

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

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

The 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, humanity had a fairly extensive knowledge of the function of the heart, some people continued to believe that this organ is the focus high feelings and courage. And even in 1982, the wife of a certain Barney Clark, a former dentist who was transplanted with 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 human heart donors.

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 designed 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, which is attached to the patient's heart, pumping blood directly into the aorta.

However, these devices have a drawback: they lead to the formation of blood clots, provoke a stroke and cause bleeding. Such devices are ineffective when it comes to patients, suffering from heart failure that disrupts the work of the right and left ventricles of the heart at the same time. Growing an artificial heart is also still a matter of the distant future, rather resembling 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 transplantation. 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. The first operation to replace this vital important body Rockefeller moved 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.

50 years ago, cardiac surgeon Christian Barnard performed the world's first heart transplant from one person to another. The operation took place in Cape Town, the capital of South Africa, at the Groot Shur hospital. Behind Barnard there were already more than one and a half thousand heart operations, and in last years before the transplant, he experimented with heart transplants in dogs. He performed 48 operations, but not a single animal lived more than 10 days.

One of the hospital patients was Luis Vaskanski, a 54-year-old native of Lithuania. He suffered from severe congestive heart failure after several myocardial infarctions against a background of severe diabetes and problems with peripheral arteries. However, to be heavy smoker it didn't bother him. In addition, due to edema, doctors performed periodic punctures of the subcutaneous fat of his legs, which, due to problems with blood vessels, led to the formation of an infected wound on the left leg.

Doctors gave him only a few weeks to live. Barnard's proposal for a heart transplant was accepted without hesitation.

On December 2, 1967, Washkansky's wife, Ann, visited him in the hospital and went home. Before her eyes, 25-year-old bank worker Denise Darval, who was crossing the road with her mother, was hit by a drunk driver. The girl's body flew off to the side from the blow, her head hit a parked car, breaking her skull. Her mother died on the spot.

Darval was quickly taken to the hospital and put on life support. However, the head injury was incompatible with life.

Denise's father signed the consent for the transplant.

"If you can't save my daughter, you must try to save this man"

- he said.

The operation took place on December 3, 1967. It started at about 1 am and ended only at 8:30 in the morning. It took more than 20 doctors and nurses to carry it out.

Washkansky lay in the operating room with his chest open and his heart already removed. “I looked into this empty chest, the man was lying without a heart, and only the artificial life support system kept him alive. It was very scary,” recalled nurse Dean Friedman, who assisted during the operation.

Denise Darval was in the next room, connected to the machine artificial ventilation lungs. Barnard ordered the machine to be turned off. Her heart was removed only 12 minutes after it stopped - surgeons were afraid of accusations that they cut out a still-beating heart.

When, finally, all the vessels were connected, those present froze in anticipation.

“The heart was motionless ... Then the atria suddenly contracted, followed by the ventricles,” Barnard later said.

The anesthesiologist called the pulse rate. 50 beats per minute, 70, 75 ... Half an hour later, the pulse reached one hundred beats per minute. The new heart successfully coped with its task.

“The mood was extraordinary. We knew everything went well. Barnard suddenly took off his gloves and asked for a cup of tea,” recalled one of the interns present at the operation.

Barnard was so excited about the success of the operation that at first he even forgot to inform the hospital management about it.

The surgeons did not film and did not even take a single photograph - all their thoughts were focused on the operation itself.

Information about a successful heart transplant was leaked to the press by one o'clock in the afternoon. Journalists were rather surprised that such an operation took place not in the USA, but in South Africa. Reporters besieged the hospital, closely following the recovery of Washkanski, who recovered remarkably quickly. On the fourth day after the operation, he even gave an interview for the radio. Washkansky became known as "the man with the heart of a young girl".

Barnard received many letters from people who learned about the operation. Not all of them were friendly and shared his enthusiasm.

“There were people who wrote very critical letters to Professor Barnard, terrible letters. They called him the butcher,” said Friedman.

In those years, the heart was perceived not just as an organ - for many it was a symbol of something more.

“You had the audacity to play God, who gives life,” the author of one of the letters reproached Barnard.

On the 12th day, Vashkansky's condition worsened. A chest x-ray revealed infiltrates in the lungs. Deciding that the cause of their appearance is heart failure due to the rejection of a donor heart, doctors increased the dose of immunosuppressive drugs. It cost Washkansky his life. He died of severe bilateral pneumonia, which caused infiltrates, on the 18th day after the operation. The autopsy showed that everything was in order with the heart.

In fact, the operation could have taken place a month earlier - the surgeons had a suitable donor heart in mind. But it belonged to a black patient, and shortly before that, a scandal erupted in the press due to a kidney transplant from a black man to a white one, which Barnard also performed. Speculative publications were highly undesirable for the start of a transplant program in a country living in conditions of racial discrimination.

Barnard soon began preparations for a second transplant, which took place on January 2, 1968. The second patient, Philip Blaiberg, lived 19 months after the operation and even managed to write a book about his experience.

Barnard's success caused a surge of surgeons' interest in transplantology, but many of them began to perform operations without proper preparation, which was accompanied by a large number of deaths. This caused a skeptical attitude towards the prospects of heart transplant operations and forced many specialists to abandon not only transplantation, but also experimental work.

Barnard continued to work in this area. By 1974, he had performed 10 operations, and one more for a heart and lung transplant. One of the patients lived after the operation for 24 years, the other for 13 years. Two are over 18 months old. Barnard also developed a heart transplant technique, in which the recipient's heart remains in place, and the donor's heart is “planted” into chest. Over the next nine years, he performed 49 such transplants and proved that this approach increases the annual survival of patients to more than 60%, and the five-year survival rate to 36%. With a conventional transplant, these figures were 40% and 20%, respectively. Improved technique and improved immunosuppressants have contributed to a marked decrease patient mortality.

Today, there are about 3,500 heart transplants a year, of which about 2,000 are in the United States. The annual survival of patients is 88%, five-year - 75%. 56% of patients live for more than 10 years.