Heart Transplant

The cardiac Clerc's Office , or heart transplant , is a surgical intervention consisting in replacing a sick Cœur by a healthy heart, taken on a donor.

History

The first heart transplant was made by Christiaan Barnard, cardiochirurgien, with the Cape in South-Africa in December 1967. It is followed by Norman Shumway to the USA a few months later.

In France, the pioneers are the professors Christian Cabrol, Gerard Guiraudon and Maurice Mercadier with the Hôpital of Pity-Salpêtrière, the April 27th 1968. The patient, Clovis Roblain, 66 years, survived only 53 hours the transplantation carried out according to the Barnard method for the Suture S and a new method of Pr Cabrol for safeguarding of the heart taken in the donor by perfusion of the coronary arteries.

The grafted first, with rare exceptions, did not survive more few weeks the intervention, primarily because of the problem of the rejections: reaction of the host against the graft considered as a foreign body.

The Années 1970 see two important progress: the safeguarding of the hearts of the donors thanks to the cold, allowing to carry out the remote taking away of the place of transplantation, and the endomyocardic biopsy allowing the early diagnosis of the rejection: a probe is introduced under radiological control and local anesthesia into a large vein and is pushed until in the ventricle right, making it possible to take of it a small piece which is examined under the microscope.

The Années 1980 see appearing the first transplantations artificial heart-lung as well as the first artificial hearts, posed generally on standby of a compatible heart. The Ciclosporine, powerful immuno-suppressor, appears during the same time, making it possible significantly to improve the lifespan of the persons receiving a transplant.

Indication

The heart transplant is proposed to the patients carrying a Cardiac failure serious and irreversible, for which the life expectancy is limited. A medical check-up and psychological complete is carried out in order to know if there exist other diseases being able to make difficult the monitoring or the regulation of certain drugs. After discussion of the file, the patient is then " put on list of transplantation" : it is then likely to be called at any hour of the day or the night and will have to go as soon as possible in the center of transplantation.

The heart transplant remains primarily limited by the low availability of the grafts (Donation of organs). The number of persons receiving a transplant (2000 /an in the USA) stagnates whereas the needs increase.

Technique

Quasi the entirety of the heart of the receiver is removed after installation of a circulation of substitution (extracorporal Circulation): only the roof of the left auricle is preserved, with its 4 pulmonary veins. The heart of the donor is then set up and sutured at the other large vessels (Aorte, pulmonary Artère, venas cava higher and lower), like with the roof of the left auricle.

Evolution

The probability of survival reaches almost 90% to one year with one lifespan frequently exceeding ten years.

The principal complications are the same ones as for all transplantations:

infectious complications secondary with the surgery but also with the immuno-depression induced by the treatment.
rejection of the graft by the Immune system of the receiver, treated by an increase in the immuno-suppressor treatment.

In the medium term, a Athérome graft appears: the coronary arteries (pertaining in the middle of the donor) narrow and are stopped), involving Myocardial infarction and a degradation of the graft.

Ventricular assistance

When the state of the patient, heart applicant of transplant, is degraded too quickly so that it can reasonably await a donor, a ventricular assistance can be installation. It is about a mechanical pump ensuring the cardiac flow during, sometimes, several months. In rare cases, the setting in rest of the heart of the patient allows a recovery of his function and thus the withdrawal of the ventricular assistance without there needing transplantation.

In other cases, the pump completely replaces the sick heart which is removed. It is then about an artificial heart whose model the most known remainder the Jarvik and whose first models date from end of the year 80.

Some famous persons receiving a transplant

Emmanuel Vitria, transplanted in 1968 and deceased 19 years later.
Charlotte Valandrey, French actress.

Notes and reference

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