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Re: Heart Transplant
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Re: Heart Transplant

Posted By CCF CARDIO MD - CRC on August 23, 1998 at 14:44:34:

In Reply to: Heart Transplant posted by Linda on August 21, 1998 at 15:30:50:






My husband, age 41 was just accepted on the heart transplant list this week (status 2) and of course we
have lots of questions about the process, attitudes, and recovery. We feel we have a good team of doctors for this, but they are
not family.
The typical antirejection drugs will be the course of action after the transplant is done, so I would enjoy your point of
view on the process and other questions we should be asking at this time. thanks.






_______
Dear  Linda,
Thank you for your question. I am sure that as you progress in the transplant process you will learn more and find it easier to talk with your husband's doctors.  The following is some information from the heart failure section here at the Cleveland Clinic (http://www.ccf.org/heartcenter/staff/cardiohrt.htm).
General Overview
Cardiac transplantation is a remarkable way to treat select patients with severe hear failure.  Indeed, few things are more impressive than observing dramatic functional improvement of an individual with advanced heart failure or cardiogenic shock after a successful heart transplant.  For many patients, transplantation of the heart is the only treatment that can markedly impact an extraordinarily high mortality.  Time has proven that this operation, and, in some circumstances, mechanical ventricular assist device implantation, is effective in diminishing morbidity and premature mortality in select patients.  
The United Network of Organ Sharing (UNOS) database contains information on over 100,000 organ transplant procedures.  Cardiac transplantation accounts for 14% (14,374) of these operations.  Kidney transplantation accounts for 52% and liver transplantation represents 19% of organ transplants done between 1988 and 1994 in the United States.  Though there has been some increase in the number of heart transplants performed since 1988, a plateau has been reached.  It appears that we will only be able to perform between 2000 and 2500  heart transplants yearly due to the low number of organ donors.
Historical Perspective
Few modern surgical procedures caused as much excitement, public interest, controversy, and dilemma as human cardiac transplantation.  Though there are parallels between the development of organ transplantation in general, and cardiac transplantation specifically, several important distinctions can be noted.  For example, the history of cardiac transplantation and mechanical assist devices development is quite intermingled, having obvious mutual interdependence.  Interesting, the concept of replacing a diseased heart to cure ailments thought cardiac in origin, is not new.  Reference though abstract, to receiving a "new heart" can be found in the Old Testament and dated to the sixth century BC where the prophet Ezekiel is said to proclaim "a new heart also I will give you, and a new spirit will I put within you; and I will take away the stony heart out of your flesh and I will five you a heart of flesh".  
Interestingly, in 1964, the first well-documented patient to undergo cardiac transplant received a primate heart rather than a human allograft.  Dr James Hardy at University Hospital in Jackson, Mississippi, transplanted the heart of a chimpanzee into a 68-year-old gentleman with diabetes, severe coronary artery disease, a diffuse peripheral vascular disease.  The gentleman had developed cardiogenic shock due to an unstable ischemic syndrome and emergency coronary bypass grafting surgery was attempted.  After failing to wean the patient from cardiopulmonary bypass, cardiac transplantation, a procedure that had been contemplated by Dr. Hardy for some time was attempted with the primate's heart.  The graft was implanted satisfactorily, with the patient partially coming off cardiopulmonary bypass.  However, the xenoheart was not large enough to maintain independent circulation for a significant period of time.  
Investigators such  as Drs. Norman Shumway of Stanford University and Richard Lower of the Medical College of Virginia were poised to perform human-to-human cardiac transplants when Christiaan Barnard of Capetown, South Africa, performed the first one on December 3, 1967.  The patient survived 18 days, dying of septicemia.  This transplant was done shortly after Barnard had spent time observing work in progress at the University of Minnesota and Stanford.  Not only did this procedure shock the public, it stirred resentment in the medical and surgical professional communities and fueled bitter discussion regarding definition of an appropriate heart "donor" particularly with respect to the concept of brain death.With development of the new immunosuppressive regimens, and, in particular, introduction of the potent and more selective agent cyclosporin in the early 1980's cardiac transplantation began in earnest throughout the world.  This new experience emerged in the setting of burgeoning renal transplant programs, experience and emerging reports of successful liver, lung and pancreas transplantation.  
Information provided here is for general educational purposes only.  Only your doctor can provide spicific diagnoses and treatments.  If you would like to be seen at the Cleveland Clinic, please call 1-800-CCF-CARE for an appointment at Desk F15 with a cardiologist.



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