Heart Replacement (Heart Transplantation)

Introduction

Heart replacement, also known as heart transplantation, is a surgical procedure where a failing heart is replaced with a healthy donor heart. This is typically performed in patients with severe heart failure or irreversible heart disease when all other treatment options have been exhausted.

Indications for Heart Transplantation

Heart transplantation is considered when a patient has: - End-stage heart failure (NYHA Class III-IV) despite optimal medical therapy. - Severe cardiomyopathy, including dilated or ischemic cardiomyopathy. - Congenital heart disease that is not surgically correctable. - Refractory ventricular arrhythmias not responsive to medications or defibrillators.

Evaluation Process

Before transplantation, a patient undergoes a thorough evaluation including: 1. Cardiac Assessment: Echocardiography, cardiac MRI, and catheterization to assess heart function. 2. General Health Evaluation: Examination of kidney function, liver function, lung function, and infection screening. 3. Psychological and Social Evaluation: To ensure the patient can manage lifelong immunosuppressive therapy.

Surgical Procedure

The procedure involves: - Removal of the diseased heart (orthotopic transplantation is the most common technique). - Implantation of a donor heart from a brain-dead or circulatory-dead individual. - Connection of the donor heart to the recipient’s major blood vessels.

Post-Transplant Care

After surgery, patients must take lifelong immunosuppressive medications to prevent rejection of the transplanted heart. Common drugs include cyclosporine, tacrolimus, and mycophenolate mofetil.

Risks and Complications

• Graft rejection (most common complication, requiring close monitoring)
• Infections due to immunosuppressive therapy
• Cardiac allograft vasculopathy (chronic rejection leading to coronary artery disease)
• Cancer risk (due to prolonged immunosuppression)

Prognosis and Survival

• 1-year survival rate: ~85-90%
• 5-year survival rate: ~70%
• 10-year survival rate: ~50%

Transplant success depends on proper post-surgical care, adherence to medications, and a healthy lifestyle.

Conclusion

Heart transplantation is a life-saving procedure for patients with end-stage heart disease. Close monitoring, medication adherence, and lifestyle changes are crucial for long-term survival.

Source recommendations

1. International Society for Heart and Lung Transplantation (ISHLT) Guidelines

1. https://www.ishlt.org/
2. https://www.jhltonline.org/article/S1053-2498(22)02185-4/fulltext
3. https://www.ishlt.org/education-and-publications/standards-guidelines-detail/ishlt-guidelines-for-the-care-of-heart-transplant-recipients
4. https://www.jhltonline.org/article/S1053-2498(21)02407-4/fulltext
5. https://www.ishlt.org/education-and-publications/standards-guidelines-detail/ishlt-guidelines-for-the-evaluation-and-care-of-cardiac-transplant-candidates

2. American Heart Association (AHA) Guidelines on Heart Transplantation

1. https://www.ahajournals.org/doi/10.1161/CIR.0000000000001063
2. https://www.heart.org/en/health-topics/congenital-heart-defects/care-and-treatment-for-congenital-heart-defects/heart-transplant
3. https://professional.heart.org/en/guidelines-and-statements
4. https://www.ahajournals.org/doi/10.1161/CIR.0000000000001168
5. https://professional.heart.org/en/guidelines-statements

3. European Society of Cardiology (ESC) Guidelines on the Management of End-Stage Heart Failure

1. https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/Acute-and-Chronic-Heart-Failure
2. https://www.ahajournals.org/doi/10.1161/CIR.0000000000001063
3. https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-14/Critical-points-for-the-practising-cardiologist-to-consider-in-their-patients-with-end-stage-heart-failure
4. https://www.heartrhythmjournal.com/article/S1547-5271%2824%2902332-4/fulltext
5. https://onlinejcf.com/article/S1071-9164(21)00050-6/fulltext