Heart transplant (heart transplantation) is a procedure performed in patients with severe and irreversible damage to the heart, in whom all alternative treatment options have been exhausted. What are the indications for a heart transplant? How long does a new heart take? How long do you live after a heart transplant?

Heart transplantis used in patients who have had irreversible, severe damage to the heart muscle, and all traditional conservative and surgical treatments do not bring any improvement. The purpose of heart transplantation is not only to extend life, but also to improve the patient's well-being.

Currently, about 100 heart transplants are performed annually in Poland, while in the USA about 2200. According to the Organizational and Coordination Center for Transplantation "Poltransplant", 99 heart transplants were performed in Poland in 2015. This is almost a third more than in 2014, when 76 such procedures were performed nationwide. In 2013, there were 87 of these transplants, and in 2012 - 79. The best was in 1999-2004, when from 105 to even 129 hearts were transplanted each year. In 2016, 101 hearts were transplanted, while the list of people waiting for a heart transplant in individual months was - January: 352, February: 368, March: 360, April 364, May: 373, June: 372, July: 385, August: 385, September: 385, October: 389, November: 391, December: 388.¹

Heart transplant - indications for heart transplantation

The indications for heart transplantation are:

  • circulatory failure
  • unstable coronary artery disease without bypassing
  • recurrent arrhythmias - ventricular fibrillation / ventricular tachycardia
  • cardiogenic shock requiring pharmacological support (administration of catecholamines) and / or the use of mechanical heart support (intra-aortic counterpulsation, single- or two-ventricular support)
  • Recurrent, severe ventricular refractory to standard therapy, including frequent cardioverter / defibrillator discharges ("electrical storms")

Heart transplant - who can donate?

The main challenge is unfortunately the insufficient number of donors. This is an extremely big problem for patientsqualified for transplant, who often wait for surgery for over a year. However, the number of donors in recent years has remained constant, neither increasing nor decreasing. This is not only due to the reluctance of society to give its heart. The methods of saving lives after accidents have improved significantly.

Which is absolutely correct. Currently, the most common donors are patients after stroke or neurosurgical failures. In recent years, transplantation of organs from donors resulting from traffic accidents has been very rare.

In Poland, patients wait for a heart transplant for an average of 14 months (data from 2016)

- The optimal donor is a patient under the age of 40, because by this age we believe that the patient does not have coronary heart disease or other pathologies. What is equally important, the weight of the donor and recipient should be similar - the difference in weight should not exceed 10-15% - explains Prof. Marek Jemielity, head of the Cardiac Surgery Clinic at the Clinical Hospital of the Medical University in Poznań.

The heart does not grow with the weight of the person, but it should be emphasized that if the donor's heart worked and worked in the body of a woman weighing about 50 kg, it may be insufficiently efficient and it may not be able to cope in the body of the recipient, who weighs 90 kg for a man. Obviously, there is no correlation that the donor for a woman must be a woman, and a man for a man. An important factor to consider is blood type. The decisive factor here is the first factor, i.e. the basic blood groups A, B, O. Rh does not play a role in this case.

Worth knowing

The first surgery was performed by Christiaan Nethling Barnard on 3.12.1967. In Poland, the first heart transplantation procedure was performed in Łódź on 01/04/1969 by the team of prof. Jana Moll, however, it ended in failure. The breakthrough came in the 1980s. On November 5, 1985, the first successful heart transplant in Poland was performed by Zbigniew Religa, the then head of the Provincial Cardiology Center in Zabrze, who was then an associate professor. Although the transplant itself was successful, the 62-year-old patient died two months later of sepsis. In the following months, the team of prof. Religi performed 4 further heart transplants. The 4th of them turned out to be the most lucky. After 4 weeks in the clinic, the patient was discharged home in a very good general condition. The Silesian Center for Heart Diseases in Zabrze is currently one of the main heart transplant centers in Poland.

Heart transplant - contraindications

  • irreversible pulmonary hypertension
  • coexisting other advanced diseases significantly affecting life expectancy
  • age>70 years old (World),>65 years old(Poland)
  • advanced lung diseases with impaired ventilation
  • irreversible kidney failure
  • irreversible liver failure
  • active gastric ulcer (until healed)
  • intestinal diverticulosis with inflammation (until healed)
  • insulin-dependent diabetes with organ complications
  • active infection (temporary contraindications)
  • active neoplastic disease or in remission period, with a length depending on the type of neoplasm
  • severe obesity BMI>30
  • advanced osteoporosis
  • mental disorders, lack of medical cooperation
  • abuse of toxic substances, alcohol

Heart transplant - how long does it take?

The selection of the "donor - recipient" is based on the blood type as well as the height and weight of the patient's body, therefore there is no "queue" concept and it is not possible "in advance" to determine the order in which the transplants will be performed. qualified sick. Hence, the waiting period varies from person to person; on average it is several or several months.

- The optimal donor is a patient under the age of 40, because by this age we believe that the patient does not have coronary heart disease or other pathologies. What is equally important, the weight of the donor and recipient should be similar - the difference in weight should not exceed 10-15% - explains Prof. Marek Jemielity, head of the Cardiac Surgery Clinic at the Clinical Hospital of the Medical University in Poznań.

Some patients awaiting a heart transplant receive mechanical circulatory support. Most often, these are artificial pumps supporting the work of the left ventricle, but some patients require the support of the right ventricle as well. Such pumps help to extend the lives of patients, so that they can survive until a heart transplant, if there is a donor for them.

Heart transplant - what is it? How long does it take?

After cutting the sternum, with the use of extracorporeal circulation (which maintains the proper blood flow in the body and oxygen supply to the body during the operation), the surgeon removes the patient's diseased heart by cutting it off at the atria or at the height of large vessels leaving the heart . Then he sews in the donor's heart (joining the atria or stumps of similar vessels).

The procedure takes several hours and in many respects does not differ significantly from other cardiac surgery procedures performed in the extracorporeal circulation.

Heart transplant - how long can you live with a transplanted heart?

It depends on agethe recipient, his general he alth, and the condition of the heart being transplanted to him. How we take care of our heart is also very important - you should not smoke, avoid alcohol, use a balanced, he althy diet. Regular check-ups are also important. You can live up to 20-30 years with a transplanted heart.

Heart transplant - quality of life after transplant

The most difficult period is the initial period, i.e. the first year of life with a new heart, but also with a number of sacrifices. Of course, we meet patients after heart transplantation in everyday life who react and function like any average person. After the transplant procedure, however, avoid large crowds of people, so as not to contract an infection. However, after one year, some patients even engage in intense sports such as cycling or running. - Personally, I am not a supporter of heart transplant recipients practicing extreme sports. However, if someone has full heart capacity and it is a young person who has all other organs functional, there is the same risk of heart problems as in people who have not undergone heart transplantation - believes Prof. Marek Jemielity.

The main contraindication to heart transplantation is severe, irreversible pulmonary hypertension.

Worth knowing

John McCafferty lived with his new heart for 33 years, the longest in the world. He died on February 9, 2016 at the age of 73. In Poland, Tadeusz Żytkiewicz is the longest-lived patient with a heart transplant. The procedure took place in Zabrze on August 4, 1987. The patient was then 61 years old.

The youngest patient in Poland with a heart transplant is four-year-old Alan Rybaniec from Zabrze. The operation took place on September 15, 2010, when Alan was 6 months old.

Heart Transplant

Source: x-news.pl/TVN24

Immunosuppressive treatment after heart transplant

After heart transplantation - as after transplantation of other organs - immunosuppressive treatment is necessary. Symptoms that may suggest rejection include: decreased exercise tolerance, shortness of breath during exercise and at rest, shortness of breath at night, palpitations, fainting, epigastric pain.

The risk of organ rejection decreases over time. It is highest in the first 6 to 12 months and then we try to achieve the highest drug concentrations.

The basic principle is to use the lowest effective doses of immunosuppressants, which allows the use of various mechanisms of action and reduction of side effects. The risk of organ rejection decreases over time. It is largest in the first 6 to12 months and then we try to achieve the highest drug concentrations.

Heart transplant - complications

Acute cellular rejection is one of the most common complications early after heart transplantation. another complication is allograft vasculopathy, also known as vascular disease of the transplanted heart, and is often equated with the chronic process of rejection of the transplanted heart.

Late non-cardiac complications in patients after heart transplantation:

  • hypertension
  • chronic renal failure
  • hyperlipidemia
  • bone complications (osteoporosis, sterile bone necrosis)
  • neoplastic disease (lymphoproliferative disease, lung and skin cancers)
  • gastrointestinal complications (gastric and duodenal diseases, cholecystitis / colonic diverticulitis / pancreatitis, diarrhea)
  • hyperglycemia
  • cataract, glaucoma
  • bradycardia
  • tricuspid regurgitation
Where to go for help

Heart transplant clinics in Poland

  • Zabrze, Silesian Center for Heart Diseases - 41-800 Zabrze ul. Szpitalna 2 tel. (032) 271-52-61… 652
  • Krakow, Department of Heart Surgery, Vascular Surgery and Transplantology Jana Pawła II Krakow Prądnicka 80 street phone (012) 634-16-003
  • Poznań, The Clinical Hospital of the Transfiguration of the Lord in Poznań, Długa Street 1/2 phone: (061) 854-90-004
  • Warsaw, Institute of Cardiology Cardinal Wyszyński Warsaw Anin, 5 Alpejska Street
  • Gdańsk, Academic Clinical Center - ACK Hospital of the Medical Academy in Gdańsk tel. (58) 349 22 22

The prosthetic heart allows the patient to survive until the transplant

Source: x-news.pl/TVN24

Source:

1. www.poltransplant.org.pl

2. While waiting for a heart transplant, Information and educational guide for the patient and his relatives, Zabrze 2013

Category:

Cardiology