Heart transplant report. Who was the first to transplant a human heart? Do they give disability

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 the ineffective long-term treatment, the doctors' confidence 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Historical reference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 considered to be a transplant human heart donor, held 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 donor organ immune system person. 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, called " 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 devices for cardiopulmonary bypass and widely used for open heart surgery;
• 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.

The era of the development of an 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 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:

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

Previously existing age restrictions (up to 65 years) are 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 of clinical types of examination. 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 drugs 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 of spontaneous.

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 arterial pressure, urine outflow.
• For pain relief, narcotic analgesics are indicated.
• For the purpose of prevention 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 normal acid-base balance is maintained.

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 measures 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.

A heart transplant is an operation of the highest complexity, involving the transplantation of a healthy organ from a donor to a recipient with serious disorders of cardiovascular activity.

Requires complex medical equipment and highly qualified personnel.

Heart transplant is the least common operation in the field of cardiac surgery.

This is due to the following factors:

• The cost of the procedure;
• A limited number of donors (persons with a functioning heart and ascertained brain death);
• The complexity of the post-rehabilitation period;
• The duration of the search for a suitable donor;
• Short-term preservation of the body in an autonomous state;
• The ethical side of the problem.

Despite the above difficulties, modern level medicine allows very successful organ transplantation with subsequent preservation of the patient's quality of life.

Who performed the world's first heart transplant?

First in the world successful transplant hearts was produced in 1962 on the territory of the USSR by the honored experimental scientist Vladimir Demikhov. The surgeon performed an operation on the animal, successfully transplanting the lungs and heart into the dog.

The first human heart transplant took place in 1964. The operation was performed by James Hardy. An animal, a chimpanzee, then acted as a donor. The life of the recipient lasted 1.5 hours.

A heart transplant from person to person was first performed in 1967 in South Africa - Dr. Christian Bernard transplanted a heart to a man who died as a result of a car accident. The 55-year-old patient died 18 days after the operation.

In Soviet times, a human heart transplant was performed in 1987. Surgery was performed under the guidance of surgeon Valery Shumakov. The recipient was Alexandra Shalkova, who was diagnosed with dilated cardiomyopathy, which threatened with an inevitable lethal outcome.

The transplantation extended the life of the patient by 8.5 years.

The operation became possible due to the introduction of the diagnosis of "brain death", in which the work of the heart, respiration and blood circulation are artificially supported. It appears that the patient is alive.

How much is a human heart worth?

A heart transplant is one of the most expensive surgeries in the world. The price varies depending on the location of the clinic and its prestige in the world ranking, the number of diagnostic procedures performed.

The cost of transplantation for each case is set individually. On average, an operation of this kind costs 250-370 thousand dollars.

The sale of human organs in the world is prohibited and punishable by law. Therefore, a heart can only be transplanted from deceased relatives, or donors, with written permission.

The patient receives the organ itself free of charge, but material costs requires directly surgical intervention, medication course as well as the recovery period.

The cost of a heart transplant in Russia ranges from $70,000 to $500,000.. The country has a quota program for patients who need high-tech operations.

The more exact cost of transplantation and the chances of its gratuitous implementation are specified individually - at a consultation with a transplantologist.

On the territory of the Russian Federation there is the only coordination center that is engaged in the selection of donors. It covers the territory of Moscow and the region.

Operations are directly carried out in Novosibirsk (NIIPK named after E. N. Meshalkin), St. Petersburg (FGBU "North-Western Federal Medical Research Center named after V. A. Almazov") and in the capital (FGBU "FNTSTIO named after V. I. Shumakov").

The principles of organ donation in Russia are not yet sufficiently developed at the official level, which becomes an obstacle to heart transplantation.

So, on average, about 200 transplants are performed in the country per year, while in the USA - more than 28 thousand. Therefore, most people with incurable heart disease need expensive surgery abroad.

Who needs a transplant?

Heart transplantation is indicated for persons suffering from pathology, which does not give a chance for a life expectancy of more than one year when using conservative methods of treatment.

• Malignant arrhythmias;
• Heart failure;
• Cardiomyopathy;
• Inoperable pathologies of the heart;
• Angina pectoris, severe cardiac arrhythmias.

The age of the patient should not exceed 65 years.

Contraindications

The main contraindications for heart transplantation are:

1. The presence of diabetes mellitus at a severe stage with persistent damage to the kidneys, retina and blood vessels.
2. Pulmonary hypertension.
3. Tuberculosis, HIV.
4. Liver and kidney failure.
5. Drug or alcohol addiction.
6. Oncology.
7. Exacerbation of mental illness.
8. The patient is 65 years of age or older.

Heart transplant for children

The positive experience of heart transplantation in adults stimulated the transplantation of vital important body children. For this operation, it is necessary to fix the death of the brain in the donor.

In world practice, the probability lethal outcome in children under five years of age after transplantation is 24%. Cause this phenomenon are postoperative complications.

At this time in Russia, the heart is represented sole body, which is not transplanted to children under 10 years old. It's all because of the lack legislative framework for organ harvesting from underage donors.

Despite the fact that transplantation is possible with the permission of the parents of the deceased child, such operations have not yet been practiced on the territory of the Russian Federation.

How to become a donor?

In anticipation of a heart transplant, patients often spend more than one year, which negatively affects their condition. As a result, many die without waiting for a rescue transplant.

Heart donors become only after death. The indicators of the body of the deceased must meet several criteria.

Namely:

• Age up to 45 years;
• Healthy cardiovascular system;
• Negative test result for HIV and hepatitis B and C;
• Brain death.

Basically, donors are victims of accidents, or those who died at work. According to the current Russian legislation, the presumption of consent to the removal of internal organs is widespread in the Russian Federation.

So, if a person has not refused posthumous donation during his lifetime, after death, his organs can be used for transplantation. But if the relatives of the deceased refuse this event, the transplant becomes illegal.

Sometimes an "artificial heart" is used to save the patient's life. It was created by the combined efforts of engineers and cardiac surgeons.

These devices are divided into:

1. Hemooxygenators that support blood circulation during open heart surgery.
2. Cardioprostheses- are used as a replacement for the heart muscle. They allow to ensure the life of a person at a qualitative level.

Devices of this type are widely used for temporary provision of blood circulation, since this moment the donor heart is less functional than the artificial counterpart.

How is the operation going?

The transplant begins with the removal of the donor heart from the body. In parallel, the patient is being prepared, who is administered analgesics and sedatives. At this time, the heart is in a special solution.

Surgeons cut off the ventricles from the heart while maintaining the activity of the atria, which set the rhythm of the contraction of the organ. After connecting with the donor atria, a temporary pacemaker is fixed (about the types of devices).

The donor organ is disposed of in two ways:

1. heterotopic- provides for the preservation of the patient's heart. The implant is located nearby. Possible complications - squeezing organs, the formation of blood clots.
2. Orthotopic – diseased heart completely replaced by a donor.

The implant automatically turns on after it is connected to the bloodstream, but sometimes it is started using an electric shock.

The average duration of the operation is about six hours. After it, the patient is placed in the intensive care unit, where his condition is supported by a pacemaker and an artificial respiration apparatus.

Data on cardiac activity is currently displayed on the heart monitor. Fluid is drained from the chest using drainage tubes.

After the operation, strict bed rest, and only after a few months you can do light exercises.

Postoperative complications

Heart transplant is one of the most complex operations. Surgery can lead to complications such as rehabilitation period and at later stages.

At the initial stage	During a year	After 5-7 years
Allergic reactions, rejection of a donor heart	Infectious invasions	Arterial dysfunction, atherosclerosis
Opening bleeding	Vascular pathology (vasculopathy)	Ischemia
Fluid accumulation in the pericardium	Malignant formations	Heart failure
Immune suppression leading to viral, fungal and bacterial infections	Implant rejection processes	Valve dysfunction

Thus, after the operation, the patient may experience bleeding at the incision site. During this period, the recipient becomes vulnerable to viral, fungal and bacterial infections.

These processes are prevented by taking antibiotics. It is also not excluded the development of the process of rejection of the implanted organ, the occurrence of myocardial ischemia.

Symptoms indicating the need emergency call to specialists in the field of heart transplantation:

• Persistent shortness of breath;
• Arrhythmia;
• discomfort and pain in the chest;
• high fever, chills;
• Indigestion;
• Puffiness, fluid retention in the tissues;
• Increasing cough;
• Blood discharge;
• problems with coordination and balance;
• Headache;
• Drops in blood pressure.

The above manifestations and the slightest deterioration in the patient's well-being is a reason for hospitalization. Timely diagnosis will eliminate the pathology without serious complications.

Prevention after heart transplant

To increase the overall life expectancy after a heart transplant, and improve its quality, following some rules will help:

1. Take special medications. The dosage and time of administration should be observed. Most of the drugs are cytostatics and hormonal drugs aimed at suppressing the immune system.
2. Avoid physical activity.
3. Follow the diet. It is strictly forbidden to drink alcohol, smoke and consume fatty foods. It is worth following a sparing diet.
4. Avoid temperature fluctuations, hot baths.
5. Avoid infections as much as possible. Do not visit places with a large crowd of people, carefully monitor personal hygiene, drink boiled water, and eat thermally processed food.

Despite a number of limitations, the life of a recipient after a heart transplant changes in better side. Observing a number simple rules, you can forget about shortness of breath, palpitations and swelling of the tissues.

Prognosis Statistics of deaths and pathologies in heart transplantation

Timely transplantation makes it possible to prolong life while maintaining a moderate physical activity and work capacity.

All materials on the site are prepared by specialists in the field of surgery, anatomy and related disciplines.
All recommendations are indicative and are not applicable without consulting the attending physician.

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

Attempts to transplant organs were made as early as the middle of the last century, but the insufficient level of equipment, ignorance of certain immunological aspects, and the lack of effective immunosuppressive therapy made the operation not always successful, the organs did not take root, and the recipients died.

The first heart transplant was performed half a century ago, in 1967 by Christian Barnard. She was successful and new stage in transplantology began in 1983 with the introduction of cyclosporine into practice. This drug made it possible to increase the survival rate of the organ and the survival rate of recipients. Transplants began to be carried out all over the world, including in Russia.

most main problem modern transplantology is the lack of donor organs, often not because they are not physically present, but due to imperfect legislative mechanisms and insufficient awareness of the population about the role of organ transplantation.

It happens that relatives healthy person, who died, for example, from injuries, is categorically against giving consent to organ harvesting for transplantation to needy patients, even being informed of the possibility of saving several lives at once. In Europe and the United States, these issues are practically not discussed, people voluntarily give such consent during their lifetime, and in the countries of the post-Soviet space, specialists have yet to overcome a serious obstacle in the form of ignorance and unwillingness of people to participate in such programs.

Indications and obstacles to surgery

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

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

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

Others no less an important factor consider the desire and ability on the part of the recipient to follow the treatment plan after organ transplantation. In other words, if the patient obviously does not want to go for transplantation or refuses to perform necessary procedures, including in postoperative period, then transplantation itself becomes inappropriate, and the donor heart can be transplanted to another person in need.

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

1. Age over 65 years (relative factor, taken into account individually);
2. Steady increase in pressure in pulmonary artery over 4 units Wood;
3. Systemic infectious process, sepsis;
4. Systemic diseases connective tissue, autoimmune processes (lupus, scleroderma, Bechterew's disease, active rheumatism);
5. Mental illness and social instability that prevent contact, observation and interaction with the patient at all stages of transplantation;
6. malignant tumors;
7. Severe decompensated pathology of internal organs;
8. Smoking, alcohol abuse, drug addiction (absolute contraindications);
9. Obesity of a pronounced degree - can become a serious obstacle and even absolute contraindication to heart transplant
10. Unwillingness of the patient to perform the operation and follow the further treatment plan.

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

Preparing for a Donor Heart Transplant

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

The recipient needs to:

• General clinical studies of blood, urine, clotting test; determination of blood group and Rh-affiliation;
• Tests for viral hepatitis acute phase- contraindication), HIV (infection with the immunodeficiency virus makes the operation impossible);
• Virological examination (cytomegalovirus, herpes, Epstein-Barr) - even in an inactive form, viruses can cause an infectious process after transplantation due to immunosuppression, so their detection is a reason for preliminary treatment and prevention of such complications;
• Screening for cancer - mammography and cervical smear for women, PSA for men.

Apart from laboratory tests, held instrumental examination: coronary angiography, which allows to clarify the state of the heart vessels, after which some patients can be referred for stenting or bypass surgery, heart ultrasound, necessary to determine functionality myocardium, ejection fraction. Shown to everyone without exception x-ray examination lungs, respiratory function.

Among the invasive examinations are used right catheterization half heart when it is possible to determine the pressure in the vessels of the pulmonary circulation. If this indicator exceeds 4 units. Wood, then the operation is impossible due to irreversible changes V pulmonary circulation, at a pressure within 2-4 units. the risk of complications is high, but transplantation can be performed.

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

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

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

Who are donors?

A heart transplant from a living healthy person is impossible, because taking this organ would be tantamount to murder, even if the potential donor wants to donate it to someone. The source of hearts for transplantation is usually people who died from injuries, in road accidents, victims of brain death. An obstacle to transplantation may be the distance that the donor heart will need to overcome on the way to the recipient - the organ remains viable for no more than 6 hours, and the smaller this interval, the more likely the success of transplantation.

An ideal donor heart would be one that is not affected ischemic disease, the function of which is not impaired, and the age of its owner is up to 65 years. At the same time, hearts can be used for transplantation with some changes - initial manifestations atrioventricular valve insufficiency, borderline myocardial hypertrophy of the left half of the heart. If the recipient's condition is critical and requires transplantation in as soon as possible, then a not quite “ideal” heart can be used.

The transplanted organ must fit the size of the recipient, because it will have to shrink in a rather limited space. The main criterion for matching the donor and recipient is immunological compatibility, which predetermines the probability of successful transplant engraftment.

Before taking a donor heart, an experienced doctor examines it again after opening the chest cavity, if everything is fine, the organ will be placed in a cold cardioplegic solution and transported in a special thermal insulating container. It is desirable that the transportation period does not exceed 2-3 hours, a maximum of six, but it is already possible ischemic changes in the myocardium.

Heart transplant technique

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

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

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

Distinguish heterotopic and orthotopic transplantation. The first way is to preserve the recipient's own organ, and the donor heart is located to the right below it, anastomoses are applied between the vessels and chambers of the organ. The operation is technically complex and time-consuming, requires subsequent anticoagulant therapy, two hearts cause compression of the lungs, but this method is preferable for patients with severe pulmonary hypertension.

Orthotopic transplantation is carried out both by suturing directly the atria of the donor heart to the atria of the recipient after excision of the ventricles, and bicaval through when both vena cava are sutured separately, which makes it possible to reduce the load on the right ventricle. At the same time, plastic surgery of the tricuspid valve can be performed in order to prevent its insufficiency later.

Continues after surgery immunosuppressive therapy cytostatics and hormones to prevent rejection of a donor organ. When the patient's condition stabilizes, he wakes up, turns off artificial ventilation lungs, doses of cardiotonic drugs are reduced.

In order to assess the state of the transplanted organ, myocardial biopsy is performed - once every 1-2 weeks in the first month after the operation, then less and less frequently. Hemodynamics is constantly monitored and general state sick. Healing of the postoperative wound occurs within one to one and a half months.

heart transplant

The main complications after a heart transplant can be bleeding, requiring a second operation and stopping it, and graft rejection. Rejection of a transplanted organ serious problem all transplants. The organ may not take root immediately, or rejection will begin after two to three or more months.

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

During the first year after surgery, the survival of patients reaches 85% and even more thanks to the improvement of surgical techniques and methods of immunosuppression. In the longer term, it decreases due to the development of the rejection process, infectious complications, and changes in the transplanted organ itself. Today, up to 50% of all patients who have undergone a heart transplant live longer than 10 years.

A transplanted heart is able to work for 5-7 years without any changes, but the processes of aging and dystrophy develop in it much faster than in a healthy own organ. This circumstance is associated with a gradual deterioration in health and an increase in the insufficiency of the transplanted heart. For the same reason, the life expectancy of people with transplanted healthy body still below the general population.

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

The cost of intervention is high, because it is extremely complex, requires the presence of qualified personnel, technically equipped operating room. The search for a donor organ, its collection and transportation also require material costs. The organ itself is given to the donor free of charge, but other expenses may have to be paid.

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

Considering acute shortage donor organs, free transplants are quite rare, many patients never wait for them. In this situation, treatment in Belarus, where transplantology has reached European level, and the number of paid operations is about fifty per year.

The search for a donor in Belarus is greatly facilitated by the fact that consent to the removal of the heart is not required in case of brain death. Due to this, the waiting period is reduced to 1-2 months, the cost of treatment is about 70 thousand dollars. To resolve the issue of the possibility of such treatment, it is enough to send copies of documents and examination results, after which specialists can provide indicative information remotely.

In Russia, heart transplantation is performed only in three large hospitals– Federal Research Center of Transplantology and artificial organs them. V. I. Shumakova (Moscow), Novosibirsk Research Institute of Circulatory Pathology. E. N. Meshalkin and the North-Western Federal Medical Research Center. V. A. Almazova, St. Petersburg.

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 like 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 the lack of 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 trying 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 tissues and successfully treat diabetes mellitus.

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.

The operation is indicated with minimal 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:

1. The operation is not performed on persons over 65 years of age, but this factor doctors evaluate individually.
2. Sustained pulmonary hypertension, which is characterized by a resistance of the walls of blood vessels of more than 4 units according to Wood.
3. Systemic infections or diseases in an active form.
4. Oncology, but at the same time take into account the predicted survival and type of tumor.
5. Smoking, alcoholism or drug addiction.
6. Psychosocial instability.
7. Unwillingness and inability to comply with the plan of therapeutic and diagnostic measures.
8. Positive HIV test.
9. 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 period of waiting for a 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 parents, without hesitation, agree to the operation in the hope of a normal future life for their child.

To the most possible complications include pneumonia, bleeding, and 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?

Heart Transplant

Description

This is an operation to remove a pathological and malfunctioning heart. It is being replaced healthy heart from a deceased donor.

Reasons for a heart transplant

A heart transplant is performed in the presence of the following pathologies:

• The last stage of heart disease, which is life-threatening and cannot be cured (but all other health indicators are normal) is performed most often due to cardiomyopathy (heart muscle disease) with severe congestive heart failure;
• Severe coronary artery disease that cannot be cured with medication or other surgery
• Congenital heart defects;
• valvular heart disease, which makes it difficult to pump blood;
• Uncontrolled and life-threatening irregular heart rhythm.

Possible Complications of a Heart Transplant

If you are planning a heart transplant, you need to know about possible complications which may include:

• Infection;
• Rejection of a new heart;
• Coronary artery disease (50% of all heart transplant recipients develop coronary artery disease);
• blood clots;
• Bleeding;
• Decreased brain function;
• Damage to other organs of the body, such as the kidneys;
• irregular heart rate;
• Problems related to anesthesia;
• Infection or cancer associated with taking immunosuppressive drugs;
• Death.

More than 80% of heart transplant patients live for at least one year after the operation. Most return to normal life, including work.

Some factors that may increase the risk of complications include:

• Age: 60 or older;
• lung disease;
• poor circulation;
• kidney disease or liver disease;
• Smoking;
• Having a serious active infection such as pneumonia or tuberculosis
• Treatment for cancer within the past five years;
• Wasting and malnutrition;
• uncontrolled diabetes;
• Previous stroke or other damage to blood vessels in the brain
• Long term abuse psychoactive substances or alcohol abuse;
• Autoimmune disease.

You should discuss these risks with your doctor before surgery.

How is a heart transplant performed?

Preparation for the procedure

There is a shortage of donors, so you can expect a transplant over a long period of time. You may need to constantly wear mobile phone, which will allow the clinic to contact you if a donor heart becomes available.

You may need to go to the hospital for monitoring and take medications regularly, including intravenously, to help stabilize the diseased heart. Some patients may have a mechanical pump called an artificial ventricle (AVV) installed. The device will help stabilize your heart while you wait for your transplant.

• The doctor will monitor your health to make sure you are ready for a heart transplant;
• Talk to your doctor about your medications. You may be asked to stop taking aspirin or other anti-inflammatory drugs one week before your surgery. You may also need to stop taking blood-thinning medications such as clopidogrel (Plavix) or warfarin;
• Do not take medicines without consulting a doctor;
• Arranging a trip to the operation and back home from the hospital;
• Arrange for home care after surgery;
• Eat the evening before the operation light food. Do not eat or drink after midnight.

Before surgery, your doctor will likely order the following tests:

• Medical checkup;
• An echocardiogram is a test that uses high frequency sound waves (ultrasound) to study the size, shape, and movement of the heart;
• Analysis of blood and tissue type;
• Tests to rule out diseases in other organs and systems that may interfere with the transplant.

Anesthesia

General anesthesia is used, which blocks any pain and keeps the patient asleep during the operation.

Description of the heart transplant procedure

After you fall asleep, the doctor cuts the skin and breastbone. The chest cavity will be opened, the vessels will be connected to a heart-lung machine (AIC). This machine performs the functions of the heart and lungs during surgery. The doctor then removes the heart. The prepared donor heart is placed in place of the patient's old heart. Finally, blood vessels will be connected to a new heart. After that, the blood begins to flow and warms the heart.

The new heart may start beating on its own, or the doctor may use electric shocks to start the heart. For safety reasons, a temporary pacemaker is placed to maintain a regular heartbeat. When the doctor is sure that the heart is beating normally, the AIC will be turned off. Temporary drainage tubes may be placed in the chest cavity to drain fluid and blood. The chest will be closed with staples and the skin will be closed with sutures.

Immediately after heart transplant

Health will be maintained and carefully monitored in the Intensive Care Unit (ICU) using the following devices:

• Heart monitor;
• cardiac pacemaker - to help the heart beat normally;
• Drainage tubes in the chest to drain accumulated fluid and blood from the chest
• breathing tube until the patient can breathe on their own.

How long will a heart transplant take?

Around 8 o'clock.

Heart transplant - will it hurt?

Pain will be felt during recovery. The doctor will provide pain medication.

Average time in hospital

This procedure is carried out in a hospital setting. Usually the stay is two weeks. The doctor may extend the stay if there are signs of rejection of the donor heart or other problems.

Care after a heart transplant

Care in the hospital

During your recovery in the hospital, you will need to:

• Breathe deeply and cough 10-20 times every hour to help the lungs work and clear them;
• Take immunosuppressants. They probably need to be taken for the rest of your life. These drugs reduce the chance that the body will reject the new heart.

Your doctor may do a heart biopsy if you have any of the following problems:

• Persistent fever;
• Problems with the functioning of the heart;
• Bad feeling;

home care

When you get home, do the following actions to ensure normal recovery:

• Take your medications as directed;
• See a cardiologist to check heart function and possibly take tissue for a biopsy;
• Work with a physical therapist. Keep in mind that a new heart will respond poorly to increased physical activity;
• Ask your doctor when it is safe to shower, bathe, or expose the surgical site to water;
• Be sure to follow your doctor's instructions.

cut in chest will heal in 4-6 weeks.

Communication with a doctor after a heart transplant

After discharge from the hospital, you should consult a doctor if the following symptoms appear:

• signs of infection, including fever and chills;
• Redness, swelling, increased pain, bleeding, or discharge from the surgical incision;
• Changes in sensation, coordination, or blood circulation in the arms and legs;
• chest pain, pressure, or heart pain;
• fast or irregular heart rate;
• Constant pain;
• cough or difficulty breathing;
• coughing up blood;
• severe nausea and vomiting;
• sudden headache or feeling weak;
• Waking at night due to shortness of breath;
• Excessive fatigue, swelling of the legs;
• Pain, burning, frequent urination or persistent bleeding in the urine.