HEART TRANSPLANTATION

Heart Transplantation is a complex procedure. It is gift of life given by an unknown person (donor) to an individual who has lost all his hopes due to poor heart condition.
Heart transplantation is a surgical operation performed on patient with End stage heart disease due to any reason. Most commonly it is done by removing disease heart completely and replace with healthy cadaveric donor heart (Orthotropic heart transplantation). In very few cases part of recipient heart is left in place to support the donor heart (Heterotrophic heart transplantation). The average survival after transplant surgery is 15 years.
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Heart transplant was first performed by Dr. Christian Bernard on 3^rdDecember 1967 at Cape town South Africa. Norman Shummway is regarded as the father of cardiac transplant. World wise approximately 3500 heart transplant were performed annually and majority of these were performed in USA. The annual frequency of heart transplant is about 1% of the general population with heart failure.

The general indications of heart transplant include deteriorating cardiac function in a patient with predictive prognosis of less than a year. The conditions responsible for this are
Dilated Cardiomyopathy(54%)
Ischemic Cardiomyopathy (45%)
Congenital heart disease, intractable angina or arrythmia with no or failed conventional therapy(1%)
Any patient of above mentioned conditions with age <65 years, PVR < 2 woods with no history of active systemic infection, malignancy or abuse and able to comply with follow up care is a suitable candidate for transplant surgery.
The preparation of patient and donor is a long tedious process which involves different specialist. After tissue mapping and availability of suitable donor surgical procedure starts. This complex procedure includes different stages starting from harvesting a donor heart, safely transporting to recipient, removal of recipient heart and finally anastomosing new heart in place.
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After the surgical part is over the success of operation is depends on how body is going to take it. In our body as a part of defense mechanism our immune systems recognize and eliminate any foreign tissue such as viruses, bacteria and even transplanted organs. The body starts rejecting organs as a protective mechanism. This can be control by immunosuppressive medications which are necessary for long term success of transplantation. Unfortunately these drugs also suppress our immune system, which is why transplant patients are more susceptible to infections and cancers of various types. To monitor rejection endomyocardial biopsy is the gold standard. This is a simple procedure done by cardiologist in outpatient setting. There is a set protocol for this procedure and immunosuppressive drugs are adjusted according to level of rejection.
The overall 1, 5, 10 and 15-year survival was respectively 77%, 67%, 53% and 42% . The functional status of patient is excellent after the surgery. Hypertension, obesity and Diabetes mellitus are associated with increase post operative mortality rates.
The major limiting factor for heart transplantation is availability of donor heart. Secondly the surgery and post operative care is very expensive. Unless the patient and family can well understand the dos and don’ts the success is questionable.

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