The Man with 2 Hearts: 25 Years from Heterotopic to Orthotopic Heart Transplantation

Abstract

Substantial technological advances in mechanical circulatory support have caused a shift in the management of end-stage heart failure. From the 1970s through the 1990s, heterotopic heart transplantation was routinely performed in patients in whom orthotopic transplantation was likely to fail. Heterotopic heart transplantation is now performed less often because modern mechanical circulatory assist devices are routinely used as bridges to orthotopic transplantation; regardless, the operation has helped numerous patients who would not otherwise have received adequate allografts. We describe the case of a man with idiopathic nonischemic cardiomyopathy who, at age 17, was given an ABO- and size-matched heterotopic allograft that was a complete human leukocyte antigen mismatch. The graft functioned normally for 20 years until the patient had a myocardial infarction that necessitated placement of a coronary artery stent. Subsequent treatments involved many interventions, including insertion of an intra-aortic balloon pump, medical therapy for heart failure, implantation of a total artificial heart, and, ultimately, orthotopic transplantation. To our knowledge, our patient is the longest surviving recipient of a heterotopic heart transplant, with a remarkable 25-year graft survival despite poor histocompatibility and an almost complete lack of native heart function. The strategies used for his treatment make him a living case study that can add valuable information to the history of cardiac support.

To hit a home run as a heterotopic heart recipient—living with two hearts for over three decades: a case report

“…To our knowledge, the longest surviving HHT recipient to date had to be relisted 22 years after transplantation. The patient's native heart was replaced with a total artificial heart, and he underwent OHT 24 years following the HHT 3 . Thus, our patient's ongoing journey following HHT exceeds by 10 years the longest survival reported to date.…”

“…The patient's native heart was replaced with a total artificial heart, and he underwent OHT 24 years following the HHT. 3 Thus, our patient's ongoing journey following HHT exceeds by 10 years To hit a home run as a heterotopic heart recipient-living with two hearts for over three decades: a case report the longest survival reported to date. It is to be mentioned that four out of the 16 adult HHT recipients transplanted in our centre displayed long-term survival of more than 10 years.…”

“… 2 However, to our knowledge, this is a case of the longest survival after HHT with a stable graft function and an uneventful follow‐up for more than three decades. 3 …”