Heart transplantation

Heart transplantation

A heart transplant, or a cardiac transplant, is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease when other medical or surgical treatments have failed.

How is it done?

As of 2018, the most common procedure is to take a functioning heart, with or without both lungs, from a recently deceased organ donor (brain death is the standard) and implant it into the patient.

Types

The patient's own heart is either removed and replaced with the donor heart (orthotopic procedure) or, much less commonly, the recipient's diseased heart is left in place to support the donor's heart (heterotopic, or piggyback, transplant procedure)

ACC/AHA guidelines

1. Refractory cardiogenic shock requiring intra-aortic balloon pump counterpulsation or LVAD

2. Cardiogenic shock requiring continuous IV ionotropic therapy (dobutamine, milrinone)

3. Peak VO2 less than 10 ml/kg/min

4. NYHA class of III or IV despite maximized medical and resynchronisation therapy

5. Recurrent life-threatening left ventricular arrhythmias despite an ICD, anti-arrhythmic therapy or catheter-based ablation.

6. End-stage congenital HF with no evidence of pulmonary hypertension.

7. Refractory Angina without potential medical or surgical therapeutic options.

European Society of Cardiology

1. Severe symptoms, with dyspnea at rest or with minimal exertion (NYHA class III or IV)

2. Episodes of fluid retention (pulmonary or systemic congestion, peripheral edema) or of reduced cardiac output at rest (peripheral hypoperfusion)

3. Objective evidence of severe cardiac dysfunction (at least one of the following): left ventricular ejection fraction less than 30%, pseudonormal or restrictive mitral inflow pattern on Doppler echocardiography, high left and/or right ventricular filling pressure severely impaired functional capacity demonstrated by one of the following: inability to exercise, 6-minute walk test distance less than 300 m (or less in women or patients who are age 75 and older), or peak oxygen intake less than 12 to 14 mL/kg/min

4. One or more hospitalizations for HF in the past 6 months.

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