Heart Transplantation

  1. What is heart transplantation?
    • Heart transplantation is the procedure by which the failing heart is replaced with another heart from a suitable deceased donor.

  2. What are the main indications for heart transplantation?
    • Severe heart failure with Left Ventricular Ejection Fraction (LVEF) < 25% - the heart is described as failing when the output from the heart is unable to maintain the circulation of sufficient blood to meet the needs of the body (1). Common symptoms associated with heart failure are fatigue, shortness of breath, joint swelling and weight gain.
    • Dilated /Ischaemic /Restrictive cardiomyopathy - this group of disorders directly damages the heart muscle, impairing its ability to pump blood to other parts of the body.
    • Valvular heart disease (congenital heart disease or rheumatic heart disease) – no therapy or failed therapy.
      In valvular heart disease, problems arise when a valve fails to close properly (mitral valve prolapse) or open properly (valvular stenosis). In either case, the heart has to work harder to pump enough blood to the body, eventually leading to heart muscle damage.

  3. In which patient is heart transplantation indicated?
  4. Heart transplantation is generally reserved for patients with end-stage refractory congestive heart failure, i.e., patient presents with symptoms despite maximal drug therapy, with an expected survival of less than one year. The patient should be younger than 65 years and able to comply with medical follow-up care.


  5. How is patient selection for heart transplantation done?
  6. The evaluation of potential candidates for heart transplantation is done by a multidisciplinary team comprising cardiologists, cardiothoracic surgeons, other specialists, nurses, allied health professionals, and transplant coordinators.


  7. What is the role of mechanical circulatory support devices in the management of heart failure patients?
  8. Mechanical circulatory support devices are indicated for patients who are listed for transplant to keep them alive and functioning as well as possible while they are waiting (bridge to transplant). The role of mechanical circulatory support devices in patients eligible for transplant has increased tremendously over the last two decades. Data from the International Society of Heart and Lung Transplantation notes that 28% of transplant recipients between 2006 and 2012 had a ventricular assist device, a marked increase from 12% in 1992-2000 (2).


  9. What are the outcomes for heart transplantation?
    • Heart transplantation is an excellent option for end-stage heart failure.
    • For carefully selected patients, heart transplantation offers markedly improved survival and quality of life. The 1-year survival rate is about 90%, the 5-year rate is about 70%, but only about 20% survive 20 years or longer (3).

  10. What is the heart transplantation scenario in India?
    • A total of 189 heart transplantations have been performed in the past three years from 2013 to 2015 (Source: Indian Transplant Newsletter).


Acknowledgement:
  1. Dr. Bagirath Raghuraman, MD,DNB,DM,FICC, FSCAI
    Vice President & Sr. Consultant Cardiologist
    Chinmaya Narayana Hrudayalaya
    Narayana Hrudayalaya Hospitals
    Bangalore.


Reference:
  1. Ross and Wilson – Anatomy and Physiology in Health and Illness (11th edition)
  2. Lund LH, Edwards LB, Kucheryavaya AY, et al. The registry of the international society for heart and lung transplantation: Thirtieth official adult heart transplant report--2013; focus theme: Age. J Heart Lung Transplant 2013;32:951-64 [PubMed]
  3. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4133547/ - Adult heart transplant: indications and outcomes - M. Chadi Alraies and Peter Eckman. J Thorac Dis. 2014 Aug; 6(8): 1120–1128.



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