Heterotopic Cardiac Transplantation: Current Status

Abstract

Heterotopic cardiac transplantation first introduced by Bernard in 1974 currently is rarely used as the procedure of choice when orthotopic cardiac transplantation can be considered. Specific indications for heterotopic cardiac transplantation include elevation of pulmonary vascular resistance and availability of a small or poorly functioning donor organ for a mortally ill recipient. Most cardiac transplant centers have abandoned its routine use because the recipient's diseased and poorly functioning heart remains as a potential source for embolism, infection, and continued angina, because the operative procedure is more complicated. Pulmonary complications are common due to compressive atelectasis of the right lung. Experience indicates that the heterotopic procedure is useful for those selected individuals in whom the orthotopic procedure is not appropriate and that rates of survival are nearly equal.

Sudden cardiac death associates with a large right atrium thrombus in a late survivor of heart transplantation

“…The dilated recipient heart has been already known as a major source of thrombus. 16 Despite of an absence of active cardiopulmonary symptom, a progressive decline of systole ejection fraction from 70%, 40% and finally to 20% was detected in consequence shortly before his death. Indeed, right ventricular failure is a major risk factor for sudden death early after heart transplantation.…”