Orthotopic heart transplantation (OHT) - is an operation during which a sick heart not working properly is removed from the chest of the recipient and is replaced by healthy donor heart. It is performed in patients with end (final) stage of heart failure when there is no effect from conservative medical treatment and the surgical intervention is impossible due to the severity of the patient's condition.
According to the register of the International Society for Heart and Lung Transplantation (ISHLT) every year in the world more than 3,800 heart transplants are performed, and patient survival over 1 year is 85-90%, more than 5 years - 72%, more than 10 years -23.9% more than 15 years - 20%.
Of course, OHT is a technically complex operation that is usually carried out in specialized medical institutions. For fast delivery of donor heart to cardiac hospital accuracy and well-functioning of the transport service is necessary.
Most important is the careful selection of candidates for this operation, both donors and recipients. The most suitable recipients are those patients who after the operation will be able to lead an active life, and to maintain or acquire efficiency.It is also important to consider how well the patient follows the prescribed treatment and complies with all recommendations. Do not neglect the importance of mental and emotional status of the patient.Not the best candidates for OTS those who are emotionally labile and follow doctor’s recommendations poorly: after the operation is vital to take a considerable number of medicines which main objective - to prevent graft rejection.
More than 70% of stable patients- recipients expect HT at home. Others need to be treated in the cardiology departments or even in the intensive care unit with intravenous inotropic agents. Often the question arises concerning the implantation of ventricular bypass as a potential bridge to the OHT.
What tests are performed for patients who have to undergo OHT? In addition to the standard clinical tests, cardiac catheterization with tonometry of right heart chambers must be performed.
This manipulation is performed before placing the patient in a waiting list to avoid irreversible pulmonary hypertension. Coronary angiography allows determining the inability to perform revascularization. In all patients with non-ischemic cardiomyopathy with symptoms of chronic heart failure endocardial myocardial biopsy should be performed.
Complete preoperative examination of recipients includes additional laboratory tests: blood glucose level study before the morning meal and after 90-120 minutes after eating (postprandial blood sugar), creatinine clearance, lipoprotein electrophoresis, identification of viral titer of antibodies and human leukocyte antigen (HLA), serology fungal infection, group and Rh factor of blood.In addition, the study of the function of the thyroid gland, abdominal ultrasound, esophagogastroduodenoscopy and screening of malignancies is essential, and carrying out of pulmonary function tests.
Regarding the donor, this one is also under investigation in several stages. At the initial stage, the collection of accurate information concerning sex, age of the patient, anthropometric data, blood group and Rh factor, general clinical and serological studies to determine the causes of death takes place.The next step is further investigation in search of potential contraindications according to electrical and echocardiography, radiography, oxygen saturation of arterial blood is carried out.At the final stage of the donor screening ventricular function and heart valves are mainly assessed.
Management of patients after OHT is based on clinical heart transplantation protocol.