Heart Transplantation

Excerpt

Patients with advanced heart failure requiring mechanical circulatory support and inotropic support have a poor prognosis. Cardiac transplantation in a selected cohort of such patients can be the treatment of choice. The early experience with heart transplants was disappointing. In 1967, the first patient to receive a heart transplant died of an overwhelming infection after 17 days. However, with the advent of immunosuppressive therapies and a better understanding of human anatomy and surgical techniques, cardiac transplantation started gaining popularity in the 1990s. The International Society for Heart and Lung Transplantation (ISHLT) reported maximum transplants during the period of 1993-2004; however, in recent years, the numbers reported have grown even further. With well-defined indications now set forth by the American College of Cardiology/American Heart Association/Heart Failure Society of America (ACC/AHA/HFSA) and European Society of Cardiology (ESC) in collaboration with ISHLT, more people are on the waiting list than is the availability of the organ itself. This review will focus on the updated guidelines on indications and contraindications of a heart transplant, commonly utilized techniques, post-transplant immunosuppression, and common complications of the procedure.