Transplantation of the heart: An overview of 40 years' clinical and research experience at Groote Schuur Hospital and the University of Cape Town: Part I. Surgical experience and clinical studies

Abstract

his team performed the world's first human-tohuman heart transplant operation on 3 December 1967. It was a major historical event and a significant breakthrough for medical science. This and subsequent events received front-page media coverage around the world for months on end, describing all aspects in detail and giving progress reports on the postoperative course of the patients.Between December 1967 and November 1974, exclusively orthotopic heart transplantation was performed. Ten such heart transplants were done, and a heart and lung transplant was also performed in 1971. [1][2][3][4][5][6] Of the 10 patients who received orthotopic heart transplants, 4 lived for more than 18 months; 2 of them became long-term survivors, one living for over 13 years and the other for over 24 years. This last patient is remarkable not only for the length of his survival but for excellent recovery from the operation in spite of severe cardiac atherosclerosis at the time of the surgery. Within 3 months he had returned to work and did not miss a single day's work until he retired 15 years later. He died from a cerebrovascular accident after unsuccessful peripheral vascular surgery and lower limb amputations.In the 1971 transplantation of a heart and both lungs, the heart was placed in the orthotopic position and the lungs were transplanted separately at the left and right main bronchi. The patient died 23 days later from pneumonia and bronchopleural fistula complications. This operation was considered quite an achievement, as two such operations were performed in the USA at about the same time, but the patients did not survive longer than a day or two. This early experience established sound criteria for the selection of recipients who would derive maximum benefit from heart transplantation. Experience was also obtained in methods of diagnosis and treatment of acute rejection. 7,8 Heterotopic heart transplantationClinical experience with orthotopic heart transplantation showed that complex and difficult-to-manage situations often emerge. It has been established that full recovery of donor heart function takes place over hours to days after transplantation. Anoxic damage and myocardial cell necrosis of the graft can occur during harvesting or at implantation, especially if myocardial protection has been inadequate or prolonged. Air embolisation to the coronary arteries often contributes to this situation. However, such damage is mostly caused by the excessive catecholamine secretion that results from brain death of the donor. Poor function of the donor heart has resulted in many recipient deaths. Similarly, many recipient deaths occurred as a result of pulmonary hypertension, as the donor right ventricle is unaccustomed to pumping against elevated pulmonary pressures, resulting in acute irreversible right heart failure. The recipient's right ventricle, although diseased, has adapted with time and has hypertrophied, making it capable of maintaining the pulmonary circulation.These observations were cause for serious concern and le...

Effectiveness of YouTube as a Source of Medical Information on Heart Transplantation

“…Since the first successful human-to-human HTx was performed in 1967, the survival quality and life span of HTx recipients have improved tremendously [2]. Between 1982 and 2009, there were 97,911 cases of HTx in the world, according to the Registry report of the International Society for Heart and Lung Transplantation (ISHLT) [3].…”

Ενεργειακή Διερεύνηση Και Προσομοίωση Της Μηχανικής Υποστήριξης Της Ανεπαρκούσης Καρδιάς Με Αποδοτικό Σύστημα

“…Heart failure is a major cause of mortality and morbidity worldwide 1 . Its treatment consists of medication and surgery 2,3 . In patients with end stage heart failure the treatment options are limited to cardiac transplantation or implantation of a mechanical circulatory support device.…”

“…Καρδιακή ανεπάρκεια τελικού σταδίου: Ιστορικά στοιχεία και θεραπείες Η καρδιακή ανεπάρκεια αποτελεί βασική αιτία θνητότητας και νοσηρότητας 1 στις ανεπτυγμένες χώρες. Η αντιμετώπισή της περιλαμβάνει φαρμακευτική αγωγή και χειρουργικές επεμβάσεις 2,3 . Στις περιπτώσεις καρδιακής ανεπάρκειας τελικού σταδίου οι θεραπευτικές λύσεις περιορίζονται στη μεταμόσχευση καρδιάς ή στην πιο πρόσφατη μέθοδο της εμφύτευσης συσκευών μηχανικής υποστήριξης της κυκλοφορίας.…”

“…Η ετήσια επιβίωση κυμάνθηκε στο 60%, ποσοστό ιδιαίτερα υψηλό για εκείνη την περίοδο. Σε σύγκριση με την ορθοτοπική μεταμόσχευση, η ετεροτοπική παρουσίασε καλύτερα αποτελέσματα 2,5 . Με την ετεροτοπική μεταμόσχευση καρδιάς διαφαίνεται μία τάση που θα προκύψει ότι κατά την υποστήριξη της κυκλοφορίας η ανεπαρκούσα καρδιά πρέπει να διατηρείται.…”