PERSPECTIVES IN CARDIAC TRANSPLANTATION: OPERATIVE TECHNIQUES AND EARLY POSTOPERATIVE CARE IN CARDIAC TRANSPLANTATION

Abstract

Although heart transplantation has become a popular therapeutic modality in only the last decade, the technical groundwork started in the early 1900s and spanned more than 60 years, ultimately leading to the first successful clinical orthotopic allograft heart transplantation in 1967(1-7). In addition to decades of work refining the operative technique, particularly over the last two decades, significant improvements in cardiac anesthesia and conduct of extracorporeal circulation, and better myocardial preservation techniques have all contributed to excellent operative outcome in heart transplantation. Today it is not unrealistic to expect a surgical mortality of well below 10%.
The following perspectives are based on the author’s personal experience encompassing close to 400 heart and lung transplant cases as Director of the Heart and Lung Transplantation Programs at the Oregon Health Sciences University, in Portland, Oregon, U.S.A.

References

1. Carrel A. The transplantation of organs: a preliminary communication. JAMA 1905/45: 1645-1650.
2. Guthrie CC. Survival of engrafted tissues. JAMA .1910/54:831-834.
3. Mann FC, Friestly JT, Markowitz J, et al. Transplantation of the intact mammalian heart. Arch Surg 1933/26:219-221.
4. Downie !1G. Homotransplantation of the dog heart. Arch Surg 1953/66:624-628.
5. Berman EF, Goldberg M, Akman L. Experimental replacement of the heart in the dog. Transplant Bull 1958/5:10-15.
6. Lower HR, Shumway HE. Studies on orthotopic homotransplantation of the canine heart. Surg Forum 1960; 11:18-22.
7. Barnard CH. The operation. A human cardiac transplant: an interim report of a successful operation performed at Groote Schurr Hospital, Cape Town. S Afr Med J 1967/41:1271.
8. Griepp RB, Stinson EB, Clark DA, et al. The cardiac donor. Surg Gynecol Obstet. 1971/133:792.

9. Billingham ME, Baumgartner WA, Watson DC,
10. et ai. Distant heart procurement for human transplantation: ultrastructural studies.
11. Circulation 1980;62(suppl I): 1-11.
12. Goldman MH, Shapiro R, Capchart J, et al. Cardiac procurement in the multiple organ donor. Transplant Proc 1984/16:231-234.
13. Hardestry LH, Griffith BP, Trento A, Starzl TE, Bahnson HT. Multiple cadaveric organ procurement for transplantation with emphasis on the heart. Surg Rounds July 1985/20-34.
14. Buckberg GD, Brazle JR, Helson RH, et al. Studies on the effects of hypothermia on regional myocardial flow and metabolism during cardiopulmonary bypass. 1. The adequately perfused, beating and arrested
15. heart. J Thorac Cardiovasc Surg 1997/73:87- 94.
16. Braun wald E. The determinants of myocardial oxygen consumption. Physiologist 1969/12: 65-93.
17. Hosenpud JD, Horman DJ, Çobanoglu, MA, et al. Serial échocardiographie findings early after heart transplantation: evidence for reversible right ventricular dysfunction and myocardial edema. J Heart Transplant 1987/6:343-347.
18. Rouchoukas HT, Harp RB. Fundamentals of clinical cardiology, Am Heart J 1976/92:513- 531.
19. Cohn JH, Franciosa JA. Vasodilator therapy of cardiac failure. H Engl J Med 1977/297:27- 31,254-258.
20. Chatterjee K, Parmley WW. The role of vasodilator therapy in heart failure. Prog Cardiovasc Dis 1977/19:301 -325.
21. Sakamoto T, Yamada T. Hemodynamic effects of dobutamine in patients following open heart surgery. Circulation 1977/55:525-533.
22. Freines SE, Weisel RD, Mickle DG, et al. A comparison of nitroglycerine and nitroprusside: II. The effects of volume loading. Ann Thorac Surg 1985/39:61 -67.
23. Lorell B, Leinbach RC, Pohost GM, et al. Right ventricular infarction. Am J Cardiol 1979/43:465-471.
24. li'c/ss Cl, Park JV, Bolman RM Prostaglandin E. for treatment of elevated pulmonary vascular resistance in patients undergoing cardiac transplantation. Transplant Proc 1989/21: 2555-2561.
25. Pierce WS, Parr GKS, Myers JL. Ventricular assist pumping in patients with cardiogenic shock after cardiac operation. H Engl J Med 1982/350:1606-1610.
26. Bolooki H. Clinical Application of the Intraaortic Balloon Pump. Mount His ko, HY: Futura Publishing Co/ 1984.
27. Gambert P, Miller JL, Lough ME. Impact of protective isolation on the incidence of infection after heart transplantation. J Heart Transplant 1987/6:147-149.
28. Bennett WM, Horman DJ. Action and toxicity of cyclosporine. Annu Rev Med 1987/37:215- 224.