Heart transplant is relatively common and is second only to kidney transplants. Improved methods of preservation, the suppression of rejection reactions by means of modern drugs, technology of cardiopulmonary bypass and intensive care possible wider application of heart transplantation in clinical practice
Indications for cardiac transplantation are chronic ischemic heart disease in the terminal stage of the disease (about 45% of all transplants of the heart), cardiomyopathy with symptoms of severe heart failure (45%), severe combined heart defects, much less – other diseases of the heart.
The criteria for selection of recipients for heart transplantation are:
- Heart failure IV degree according to the classification of the New York Heart Association or the life expectancy of patients less than 6 months;
- Age of the recipient – from newborn period to 60 years (in some centers up to 65 years);
- Satisfactory condition of the patient before the appearance of signs of the final stage of heart disease;
- The recipient must be a normal function or easily reversible, temporary dysfunction of the lung, liver, kidney, central nervous system;
- Emotional stability and interpersonal skills;
- Pulmonary vascular resistance should be normal or amenable to pharmacological correction;
- The recipient must not be actively developing an infection or cancer process, has recently migrated pulmonary embolism, severe vascular disease.
When choosing a method of treating physician must be convinced that the heart transplant is the only way to prolong the patient’s life, that all the features of other methods of treatment of severe heart disease have been exhausted.
Contraindications to heart transplantation are:
- Systemic diseases (eg, insulin-dependent diabetes, is not amenable to correction of chronic kidney disease, central nervous system, mental illness, infection in the body);
- High blood pressure in the pulmonary artery (pulmonary hypertension);
- Marked obesity, alcoholism or drug addiction.
The criteria for donor selection. As a donor for a heart transplant must be picked up by people with healthy hearts, possibly younger than 60 years with clinically established brain death. Cardiac activity Donors should support hypertensive drugs a short period of time. Donor and recipient must have the same blood group. In the blood serum of the recipient should not be preformed antibodies against donor lymphocytes. The donor must have a normal ECG and echocardiogram. Dimensions donor organ can range from 20 to 50% of the size of the heart recipient.
Heart transplant performed only in the departments of cardiac surgery, have experience of cardiopulmonary bypass with cold cardioplegia, where there are appropriate facilities and qualified personnel.
Online access – median sternotomy. After opening the pericardium introduce cannula in the lower and upper hollow vein to connect the apparatus of artificial circulation. Duration of cardiopulmonary bypass and cold cardioplegia should be as short as possible.
Heart donor and recipient are excised nearly completely, leaving small sections of the rear wall of both atria (the confluence of the hollow vein into the right atrium and the place of confluence of the pulmonary artery into the left atrium). After inspecting the prepared accordingly his heart donor seaming with the rest of the rear wall of the left atrial septum between them, the remainder of the right atrium, the aorta and pulmonary artery of the recipient. After removing the clamp from the aorta, arrange for the speedy recovery of heart rate, if it does not recover on their own.
Immunosuppression was carried out according to general rules. In recent years, the scheme of immunosuppression include monoclonal antibodies (OKTZ, etc.).
During the first year after surgery survive approximately 80% of patients after 5 years – about 64% and after 10 years or more – 45%.
The reaction of rejection manifested arrhythmia, hypotension, fever, weakness, shortness of breath. ECG not informative. To detect early signs of rejection reactions using endocardial myocardial biopsy, followed by study of its histological structure. Routinely used as radioisotope ventriculography, which allows you to monitor the reaction of rejection and changes in immunosuppressive therapy.