Due to the high cost and some physiological and moral – ethical features, heart transplantology is one of the rarest areas in cardiac surgery.
- These features include:
- A limited number of potential donors.
- A donor can be a person without the presence of cardiac abnormalities and ascertained brain death.
- Limited time donor search.
- The selection of a donor according to waiting lists takes a long period of time, especially during heart transplant surgery in childhood.
- Ethical issue.
- Disapproval by religious organizations of the idea of organ transplants.
- Duration and high cost of rehabilitation measures
- The storage time of donor biomaterial should not exceed 6 hours
Despite these difficulties, operations, albeit in small quantities, have been successfully carried out.
A general indication for which a heart transplant is required is a pronounced decrease in the functions of the heart organ, with the impossibility of conservative treatment and a short life expectancy. With the ineffectiveness of traditional methods of treatment, symptoms – the impossibility of physical activity without the manifestation of symptoms, a significant fluid retention in the body and a violation of the respiratory rate may require a heart replacement.
A condition requiring heart replacement occurs as a result of diseases:
- Hypertrophic cardiomyopathy of the heart.
- Myocardial damage with an increase in heart size. It is expressed in the gradual replacement of the heart muscle cells with connective tissue, which leads to a violation of the heart rhythm. It can be triggered by dilated and ischemic cardiomyopathy.
- Heart defects of different nature
- Tumors of the heart of various nature
- Severe cardiac dysfunction, not amenable to conventional treatment.
In addition to these reasons, the data of complex examinations, which include ultrasound and pulmonary catheterization data, are mandatory taken into account. It can be considered an indication for heart transplantation with a fraction of less than 20% and the absence of severe pulmonary hypertension.
Transplantation cannot be performed if there are contraindications for heart transplant surgery:
- Severe diabetes.
- Human immunodeficiency virus, an active form of tuberculosis.
- The presence of foci of acute infections.
- Acute renal and liver failure.
- Severe forms of impaired immunity.
- Severe form of chronic obstructive pulmonary disease.
- Alcoholism and drug addiction.
- Severe pulmonary hypertension.
- Mental disorders in the active stage.
The main indications for heart muscle transplantation are severe heart diseases that cannot be cured by drug therapy.
A transplant operation is an extreme measure, which is resorted to only in extreme cases, when all other methods of treatment do not give the desired result.
The operation is required when:
- Congenital heart disease and its valves
- Dilatation and ischemic cardiomyopathy in which myocardial replacement is performed with connective tissue
- Idiopathic cardiomyopathy
- Low blood pressure
- Atherosclerosis of the coronary arteries
- Malignant angina pectoris
- Heart failure (chronic systolic go diastolic) with the onset of symptoms of the disease, not only during exercise, but also at rest
- Benign tumors
- Chronic coronary heart disease
- Heart arrhythmias
- Damage to the heart by viruses of various origins
A vital operation is if, with the development of the disease, specialists predict a reduction in life line to less than a year. In some cases, it is transplantation of the heart muscle that gives people with severe heart pathologies a chance to save their own lives.
In some cases, heart muscle transplant surgery may be contraindicated. This may be due to:
- Vascular disease
- The presence of cancer
- Patient age (transplants are not performed for people over 65)
- Serious diseases of the patient’s blood or organs
- The presence of serious infectious and chronic diseases that are in the acute phase (ulcers, tuberculosis, hepatitis, HIV infection)
- Severe mental disorders
- Problems with alcohol and drugs
- The presence of diabetes
- Pulmonary Thromboembolism
- Pulmonary hypertension (high blood pressure)
- Autoimmune diseases
- Pulmonary, hepatic, or renal failure with impossibility of drug therapy
If any of these problems exists, the request for the operation may be rejected, since the probability of its success is minimized. In addition, when operating patients with some of these problems, the doctors themselves are significantly at risk of infection.
When is a heart transplant operation needed?
Heart transplant surgery most often leads to the need
dilated cardiomyopathy, when the size of the heart begins to increase,
the heart muscle is “stretched,” and its contractions are becoming weaker. Second place among diseases leading to need
heart transplants, ischemic heart disease, often leading to
the formation of myocardial infarction with subsequent scar fields, which leads to a loss of heart ability to perform
effective reductions. A small percentage of patients who are shown a transplant
heart, are patients with valvular defects.
In order to extend the life of the patient until it is
found a donor heart, he has to apply, in expression
transplantologists, “bridge”, i.e. one or another technique that improves blood circulation.
The first of these is the “pharmacological bridge” – the intensive use of powerful
Often these medicines after some
time is no longer able to provide the desired level of blood circulation in the body,
then you have to go to the “mechanical bridge” – the use of various
mechanical pumping devices – an artificial heart that is partially, and
sometimes it fully ensures blood circulation.
Donor Heart Requirements
A heart donor is a person with a pronounced death of the brain due to injuries incompatible with life or due to a vascular accident. The functional activity of the heart in donors is provided by the artificial life support apparatus.
Most often, such patients are admitted to the hospital after an accident or cerebral hemorrhage. That is, a person in this state is actually dead, and the life support of the body is supported by artificial means. During the operation, the heart will begin to function independently in the new body.
A commission is being made up of the clinic’s specialists and the chief physician of the medical institution of the observing donor, and the necessary documents are being prepared. According to the commission, a surgeon and an assistant are sent from the transplant center and the donor heart is removed and transported to a specialized institution.
It is necessary that the donor’s heart for a heart transplant operation be absolutely healthy and meet the following parameters:
- Lack of heart disease.
- The absence of malignant neoplasms.
- The absence of human immunodeficiency viruses, hepatitis C, B (HBV) and hepatitis C (HCV) in the blood.
- The blood group of the donor and recipient must be compatible.
- Compatibility of the size of the hearts of the donor and the recipient.
When transplanting a donor heart, a lot of criteria must be taken into account. In particular, the organ of the donor should be suitable for the patient in a number of ways. So the body should:
- Have a blood ejection fraction of at least fifty percent
- Donor age must not exceed forty-five years
- Suitable recipient for blood type and Rh factor
- Fit for immunological parameters. This is especially important, because if a donor or recipient has specific antibodies, the reaction of rejection of a transplanted organ as a foreign body may develop
- The heart of the donor must be healthy, not carry any pathologies
- Anatomically correspond to the organ of the recipient. Allows a difference of twenty to fifty percent
Since the donor heart is most often extracted posthumously, doctors are also required to evaluate the degree of heart concussion. If it passes through all the parameters, the heart is lowered, for storage, in a special solution and transported to the clinic in a specialized container.
It is also interesting that in India, the heart is primarily transplanted to patients of the city in which the donor lived. If the heart was not in demand, the proposal goes to the clinics of the state, then the country. Only if the heart was not in demand or did not suit any of the inhabitants of the country, can it be transplanted to foreign citizens.
What you need to know before transplantation?
Life after a heart transplant
After transplantation, the patient’s life consists of a number of such components as:
- The systematic use of drugs – cytostatics and a variety of hormonal medications. This aspect is one of the most important. Taking medications should strictly comply with the time and dose prescribed by the doctor. Drug therapy in the postoperative period is mainly aimed at suppressing rejection of the donor organ, which can be perceived by the immune system as a foreign body
- Compliance with the rules of physical activity. So, during the first month you must adhere to all the rules and restrictions. After two months after the operation, it is allowed to return to driving the car, and after a couple of months it is recommended to start physical education: light gymnastics or walking
- Proper nutrition. This item includes a complete rejection of the consumption of alcoholic beverages. In addition, it is recommended to give up cigarettes and exclude fried, smoked and fatty foods from the daily diet.
- Protection against any infectious diseases. After the operation, it is recommended to avoid contact with patients, not to visit crowded places and be sure to follow the rules of personal hygiene. In addition, consuming food is only those products and water that have been processed at high temperatures. All these precautions are related to the fact that immunity inhibited for engraftment of a donor heart may not withstand the attacks of various viruses and bacteria. This can lead to serious illnesses and complications.
Life after the operating period, of course, undergoes some changes, but the patient gets a chance to live on. To live without constantly shortness of breath, a frequent heartbeat and a systematic manifestation of edema.
Video about how a person lives after a heart transplant.
In order to avoid
there was a rejection of the donor organ is necessary to comply with a number of rules.
First of all, it is necessary that the donor and recipient be similar in antigens
histocompatibility, which in humans are integrated into the HLA (Human
leucocyte antigens). Based on the results of the compatibility test, the most suitable donor and recipient are selected.
Using the second
test (cross-match) identifies potentially dangerous
antibodies in the recipient that can damage the graft. If there are a lot of them in the blood of the recipient, high
the probability of rejection of the donor organ.
Due to the reaction of the body’s immune system to a foreign organ, after heart transplantation, it is necessary to take medications that do not allow the body to reject the donor heart. A person with a transplanted heart needs to be in regular contact with the attending physicians, especially
cardiologists. Specialists of the NMIC in the clinic and after discharge will monitor your condition
health, do tests to make sure your new heart works
right. In the first year after surgery, it is necessary to treat your health with special care to avoid infectious
In most cases, people feel good after surgery.
They can go to work and lead an active lifestyle. In the Clinic them. Acad. E.N. Meshalkin annually several transplants are performed. Experienced specialists carry out this complex procedure at the highest level. Caring medical staff helps to make the period of waiting for the donor organ and the postoperative period as comfortable as possible for the patient.
Patients experiencing the need for a heart transplant should contact the transplant center and register as a person in need of surgery. The referral is issued by an observing physician by a cardiac surgeon or cardiologist, if there is an indication for a heart transplant operation. Transplantation centers conclude an agreement with specialized medical institutions where potential donors may appear.
After registering a patient as requiring surgery, it may take a long time before the operation itself, if it is not possible to find a donor, the patient runs the risk of dying without waiting for a transplant. When finding a suitable donor, surgery is prescribed in the near future.
According to the legislative act on the ban on organ trafficking, adopted around the world only cadaveric and related transplantation is allowed. Thanks to this, only the cost of the most surgical intervention of medicines before and after the operation and rehabilitation enterprises is paid. The heart itself is not paid.
Typically, the cost of heart transplant surgery is 250 thousand dollars, but it can reach half a million.
The Russian center, which carries out the selection of donor organs, operates in the capital of our country. Heart transplant operations are carried out in specialized centers in Moscow, Novosibirsk and St. Petersburg.
Now in the Russian Federation there is no detailed legislative framework regulating the basic principles of tissue transplantation. This is one of the reasons for the rarity of this type of operation – in 2014, only 200 were performed, and, for example, in the United States over the same period of time, 28 thousand were performed.
Also, gaps in the principles of organ transplantation for children, in particular the ban on organ removal from patients under 18 years of age, necessitated treatment abroad. Only in 2015, a legislative act was passed on the procedure for stating brain death in people older than 1 year. Which opens up opportunities for improving the regulatory framework in the field of child donation.
Preparing for an operation
Heart transplant: preparation for surgery
A comprehensive examination of the patient before the donor organ transplant procedure is the usual and mandatory procedure, which makes it possible to minimize the possible negative consequences. The survey includes:
- Comprehensive blood tests for various diseases: hepatitis, AIDS and others
- Checking the patient for fungal infections and sexually transmitted diseases
- Checking the patient for infectious and viral diseases
- External respiration check
- X-ray, CT, MSCT, MRI
- Coronary angiography
- Diagnosis for malignant tumors
Carrying out an operation on the heart muscle involves a serious comprehensive checkup, which will be able to protect both the surgeon and the patient from possible problems. That is why the preoperative check includes a complex of diverse tests that can more accurately determine the picture of the patient’s condition, which is extremely important in preparation for transplantation.
When a patient contacts a specialized transplantology center, and includes him in the transplantology queue, an examination plan is drawn up and preoperative preparation is carried out, which includes:
- Chest X-ray.
- Blood tests for viral infections.
- General clinical analysis of urine.
- Ultrasound examination of the heart, electrocardiogram.
- Cardiac surgery specialist examination.
- Dental examination.
- Clinical blood test .
- Inspection of the otorhinolaryngologist.
- Gynecological or urological examination.
A patient who is on the transplant list should be ready to urgently arrive at the transplant center when a donor is found.
For this, the necessary documents must always be with you:
- All-Russian passport, compulsory medical insurance policy and pension certificate.
- Extracts and analysis results from sending institutions.
Performing an operation
Typically, a heart transplant operation lasts no more than 6 hours:
- A heart transplant operation starts from the moment the heart is removed from the donor’s body and immersed in a special fluid. At the same time, preparations are made for the heart transplant operation of the recipient, consisting in the introduction of painkillers and psycholeptics.
- The operation is performed under general anesthesia. First, the front part of the recipient’s chest is opened, and large blood vessels are attached to the heart-lung machine.
- Then the ventricles of the heart are cut off and the atrium is left. This is done so that the sinus node responsible for the rhythm of the contractions of the heart continues to function.
- Then, the recipient of the donor’s atrium is sewn to the atria of the heart and a pacemaker is installed to ensure normal indicators of heart contraction in the postoperative period.
- The chest is sutured and a bandage is applied.
- After the operation, immunosuppressive and cardiotonic measures are taken.
Placement of a donor heart in the chest
Despite the high level of development of modern science and medicine, there is still a high probability of developing complications in the early and late postoperative periods. The main ones include:
- Oncological diseases – myelomas and lymphomas. Their development is due to the use of potent immunosuppressive immunosuppressive drugs
- The development of pneumonia and candidiasis due to a drop in immunity
- The development of tissue ischemia, which occurs as a result of prolonged transport or more than four hours of storage of the donor organ
In order to minimize the likelihood of progression of any complications, the patient after the operation must strictly follow the instructions of the doctors: take the prescribed drug in exact accordance with the dosage and undergo regular examinations.
In addition, it is recommended to consult a doctor immediately with:
- Shortness of breath
- The appearance of pain in the sternum
- Severe cough
- Manifestation of edema
- Systematic migraine and dizziness
- Feeling nauseous and vomiting
- Coordination failures
- Irregular blood pressure
If you feel unwell at any stage of therapy, it is recommended that you immediately inform your doctor. Otherwise, it is possible not only the development of serious complications, but also a fatal outcome.
Heart transplantation can be performed both in Russia and in India. Despite the difference in transaction prices, the quality of the services provided will not differ. In any case, the most important thing is time, because any delay can become fatal for the patient.
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Early postoperative period:
- Bleeding and infections. When bleeding occurs, the incision site is opened and the source (place) of bleeding is sutured. To prevent infectious complications, antibiotics are prescribed and immunosuppression is performed.
Late postoperative period:
- There is a likelihood of rejection of the graft and disruption of the normal functioning of the coronary arteries leading to the development of coronary artery disease.
Heart transplant, predictions
Due to the current level of development of medicine, forecasts are generally favorable. It is guaranteed that:
- 88% of the operated will live more than a year
- 72% – five years
- 15% – up to twenty years and more
The difference in the percentage ratio is due to the numerous responses of the body to the transplanted heart, as a result of which various pathologies of valves and blood vessels can develop.
To avoid such problems, in recent years, before the organ transplant procedure, an additional strengthening of the tricuspid valve and preliminary elimination of other shortcomings of the donor organ are often carried out.
The postoperative prognosis is positive – 90% of the operated on live more than one year, 60% – more than five years, and about half of the total operated can live more than 10 years.
Life after surgery
Heart transplantation imposes certain restrictions on the subsequent lifestyle after surgery:
- Taking medications. The most important stage of the postoperative period. It is necessary to carefully observe the dosage and time of taking medications.
- Physical activity . In the first months, a mode of limited activity is observed that does not extend to daily activity. You can start driving a car after 2 months, 4 months after the operation, you need to turn on light physical activity.
- Nutrition. Nicotine and alcohol are eliminated and a strict diet is introduced.
- Infection protection. Increased likelihood of contracting various infections due to immunosuppressive therapy and inhibition of their own immunity. It is recommended not to visit crowded places and to observe preventive measures of personal hygiene.
The attitude of various religious denominations toward transplantology has always been difficult. A heart transplant from a religious perspective was considered tantamount to killing, since an organ is taken from a living person and there is a theoretical possibility of a person leaving a coma after some time.
However, the attitude is gradually changing, thanks to the legislative differentiation of the concepts of coma and brain death. Therefore, recently, a large number of church ministers are of the opinion that helping another person survive after death is the mission of a truly believing person.
Cost in Russia and India
The cost of the operation may vary. According to the latest data, transplantation in different countries will cost different amounts. So, for example:
- In Russia, the price of an operation starts from 100 thousand dollars, as in the Republic of Belarus
- In Europe, the operation is estimated at 200 thousand euros
- In clinics in Israel and Germany, transplantation will cost from 350 thousand dollars
- In India, from 70 thousand
As you can see, the most expensive is a transplant in European countries, and the least in India. However, the difference in prices does not at all indicate that lower-skilled specialists are working in India.
How long to wait for the operation?
Heart transplant operation
First of all, for transplantation, a waiting list should be drawn up for patients. You can compose it in the centers of transplantology, which collaborate with clinics where donors can appear.
From time to time, the centers redirect requests to the clinic for the presence of a likely donor. Upon receipt of response data on probable donors, a comparison is made with the list of recipients and selection is carried out according to indicators of their compatibility.
You can get a redirect to the center for organ transplantation and compilation of a sheet at the cardiologist or cardiac surgeon in whom the patient is observed.
The waiting time for an operation depends primarily on when a suitable donor appears in the clinic. If it is detected soon, the transplant can be carried out within a couple of weeks. However, if the donor has not been found, the wait may be delayed for a long time, which patients often do not survive.
Since the main problem in chronic heart failure is precisely the lack of time (death is predicted before the end of the year), the search for a donor should be carried out as quickly as possible, since any delay can lead to death.
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