Heterotopic heart transplantation operative techniques in. An accurate diagnosis was made by selective right and left sided electrocardiography. Heterotopic heart transplantation hht is a surgical procedure that allows the graft to be connected to the native heart in a parallel fashion to provide a kind of biological biventricular support. Heterotopic heart transplantation oxford academic journals. Orthotopic heart transplantation oht is a well established and. The patient presented with an anterior myocardial infarction mi in 1989 and an inferior mi seven years later. The heterotopic cervical heart transplantation in mice is a valuable tool in transplant and cardiovascular research. Material and methods presently patients being considered for heterotopic car diac transplantation are required to have not undergone a. The surgical technique of heterotopic heart transplantation.
We conclude that heterotopic heart transplantation is a lifesaving procedure in urgent cases when only small donor hearts are available, and that it offers a good chance of hemodynamic and functional improvement not only in emergency cases, but also in cases of chronic cardiomyopathy when there is salvageable myocardium. For the working heart model, an en bloc of heart and lung was placed in the. The recipient still has a heart if the donor heart is rejected. He had nonischaemic cardiomyopathy and had undergone a heterotopic heart transplantation hht 24 years earlier. Based on extensive experimental work 3, a form of heterotopic transplantation was carried out whereby the donor heart acted solely as a left ventricular assist device 2. Diastolic function in the heterotopic rat heart transplant. Heterotopic cervical heart transplantation in mice protocol. The first heterotopic human heart transplant was performed in 1974 by dr. Diastolic function in the heterotopic rat heart transplant model effects ofedema, ischemia, and rejection decreased systolic ventricular function and compliance and increased left ventricular edema and mass have been demonstrated in cardiac allograft rejection. Sphingosine 1phosphate receptor modulator fingolimod. Heterotopic heart transplantation in the rat receiving fk.
Emphasis is placed on ensuring nonrestrictive anastomoses between the left and right atria of the recipient and the donor. Potential of heterotopic cardiac transplantation in mice. More than 3 decades have passed since the first heterotopic heart transplantation hht was reported. Our unit revisited heterotopic transplantation in response to a growing number of waiting list. Heterotopic heart transplantation heart, lung and circulation.
While it was more widely utilized in the precyclosporine era to provide adjunct circulatory support in combination with the native heart, associated complications as well as improved longterm graft survival have now established orthotopic transplantation as the procedure of choice. Methods since the beginning of the transplant program at harefield in 1980 until march 1996, 1278 cardiac trans. This surgi cal technique, described in 1974 by barnard and losman 5 in humans, combines the safety of heterotopic abdominal trans plantation with the benefits of a working heart model 6,7. The effect of cyclosporine on acute rejection saw the heterotopic transplantation technique wane. His severe pulmonary hypertension necessitated a heterotopic transplant, with the native heart maintaining the right circulation while the donor heart. Combined abdominal heterotopic heart and aorta transplant. Successful heterotopic heart transplantation in rat.
Heterotopic heart transplantation hhtx has been a treatment for endstage heart failure since the 1970s. Immunosuppressive drugs have been used in transplant surgery units for over 20 years. Karen vitak, in acute care handbook for physical therapists fourth edition, 2014. The surgical technique of heterotopic heart transplantation is detailed and illustrated. Rat heterotopic heart transplantation model to investigate. Starzl in the first in vivo demonstration of immunosuppression by fk506 fk, ochiai et all used inbred rats. Two types of rodent heterotopic heart transplantation models were adapted for this study using lewistofisher344 rats.
There are two standard operations for performing heart transplantation orthotopic, in which the recipient heart is excised and replaced in the correct anatomical position by the donor heart, and heterotopic the socalled piggyback heart transplant, in which the donor heart is placed in the right chest alongside the recipient organ, and anastomosed in such a way to allow. Heterotopic heart transplantation and native heart. Operative techniques in thoracic and cardiovascular surgery volume 21. At age 11 months, the patient underwent a heterotopic cardiac transplantation. The surgical techniques of orthotopic and heterotopic. This clinical case study shows the importance of heterotopic heart transplantation hhtx and also the indications, evolution and complications of selected patients. Heterotopic heart transplantation is seldom used but may be due a renaissance.
The heterotopic heart transplant is a good viable option for severe pulmonary hypertension patients, and, severe pulmonary vascular resistance patients, who would otherwise, not qualify for an orthotopic heart transplant. Early experimental work was mainly by the russian surgeon demikhov and subsequently by others, but it was barnard and losmans techniques of implanting an auxiliary heart in the chest in 1974 that led to the initiation of a clinical program. The more common orthotopic procedure involves a median sternotomy with removal of the recipients heart and the insertion of the donor heart in the normal anatomic. Effects of ling zhi on cardiac heterotopic transplantation. The changes in native heart ventricular dysrhythmias after heterotopic transplantation and revas cularization are described. Heterotopic heart transplantation hht was developed for experimental purposes serving as an alternative technique to orthotopic transplantation, mainly because it does not require a cardiopulmonary bypass, which has not been realized in murine models so far. The outcomes for these recipients have been comparable to survival outcomes for similar orthotopic heart transplant recipients.
Honoring 50 years of clinical heart transplantation in. Heterotopic heart transplantation in the rat receiving fk506 alone or with cyciosporine n. Five of the 10 heterotopic transplantation recipients received donor hearts under. We present a case of heterotopic heart transplantation in a 47 year old man who had postischaemic dilated cardiomyopathy. Heterotopic heart transplantation was first performed in humans in 1974, the main advantage being the continuing function of the patients native heart, in the event of lifethreatening acute rejection. Orthotopic and heterotopic transplantation are the two types of heart transplant procedures. Heterotopic heart transplantation hht has a long history in the experimental laboratory chapter 18. In a left assist configuration, heterotopic heart transplantation could expand the pool of heart donors and also enable transplantation in groups of patients who are currently not eligible for a heart transplant. Methods an 8monthold girl presented in 1994 with signs of severe heart failure, secondary to dilated cardiomyopathy. Although a heterotopic transplant can be advantageous in some situations, the medical followup is more complicated and. Therefore, we developed a combined heterotopic abdominal heart and aorta transplantation model in mice, which is aimed at improving our understanding of the progressive nature of av, reducing animal and drug utilization and further. A heart transplant, or a cardiac transplant, is a surgical transplant procedure performed on patients with endstage heart failure or severe coronary artery disease when other medical or surgical treatments have failed. Fourteen of our 20 heterotopic heart transplant recipients had undergone previous surgery for ischemic heart disease. Heterotopic heart transplantation in rats has become a substantial tool for numerous investigations.
European journal of cardiothoracic surgery, volume 44, issue 2, august. The donor heart was transplanted into the thoracic cavity with the native heart remaining in place. From the department of cardiac surgery, groote schuur. Permission granted by annals of thoracic surgery for. It was soon found that azathioprine on its own failed to prevent rejection even in. The donor aorta and left pulmonary artery are anastomosed to the recipients abdominal aorta in an endtoside fashion. The barnard heterotopic heart transplant technique with an interposition dacron graft. This report describes a surgical technique of infrarenal heterotopic heart transplantation with a prodigious surgical success rate which was developed over many years of practice. He was a south african doctor who also performed the first orthotopic transplant. Typical indications have included a high transpulmonary pressure gradient tpg 15 mmhg, donorrecipient size mismatches, and a high risk of graft rejection. Working heart model of heterotopic heart lung transplantation in rats a technique for a working heart model of heterotopic heart lung transplantation is described. Although heterotopic heart transplantation had a long history in the experimental laboratory, it was first used clinically in 1974 by losman and barnard.
The implantation of a natural auxiliary heart using the technique of heterotopic heart transplantation hht may be on a permanent basis, or may occasionally be temporary as a means of support whilst recovery of the patients own heart is awaited or a more definitive procedure is planned as will be outlined later. Get a printable copy pdf file of the complete article 548k, or click on a. Heterotopic transplantation an overview sciencedirect. University of arizona, department of surgery, cardiac surgery, 1501 n. Coronary radiography showed a double vessel disease and ventriculography an ejection fraction of 0. We present a case of using the donor heart as a biologic left ventricular assist biolva. Total artificial heart salvage of a heterotopic heart. The cuff technique greatly simplifies this model by avoiding challenging suture anastomoses of small vessels thereby reducing warm ischemia time. Heterotopic heart transplantation has a long history in the experimental laboratory l but was not attempted clinically until 1974 2. Allograft vasculopathy av remains a major obstacle to the longterm allograft survival. Successful catheter ablation of recipient left ventricular. The patients original heart assists the donor heart in healing from any injury sustained during the transplant procedure. Heterotopic, heart transplantation, thoracic surgery, heart failure. A 41yearold man with acuteonchronic decompensated heart failure presented for evaluation for heart transplantation.
During a heterotopic heart transplant, the heart of the patient is not removed before implanting the donor heart. Orthotopic transplantation an overview sciencedirect. Perioperative telemetric monitoring in pig tobaboon. Hospital and university of cape town medical school. The heart transplant recipients n d60 are categorized into group a control and group b. While it was more widely utilized in the precyclosporine era to provide adjunct circulatory support in combination with the native heart, associated complications as well as improved longterm graft survival have now established orthotopic transplantation as the procedure of. In this case, for the first time, the syncardia 50cc total artificial heart tah syncardia systems, llc, tucson, az was used as a rescue therapy on a hht patient. Recently, heterotopic thoracic heart transplantation has successfully been implemented as a third alternative. The heterotopic procedure allows for the possibility of the patients heart to recover with the help of the donor heart. The donor heart is excised after cardioplegic arrest and topical cooling. As of 2018, the most common procedure is to take a functioning heart, with or without transplanting one or both lungs at the same time, from a recently deceased organ donor.
Heterotopic heart transplant hht has traditionally been thought of as creating 2 parallel circulations. Heterotopic heart transplantation was initially developed in the laboratory for experimental transplantation. A case is reported of haemodynamic collapse in a 51 year old male heterotopic heart transplant recipient caused by native heart ventricular tachycardia. Ecg diagnosis of native heart ventricular tachycardia in a.
From apex to base, each section contains native and transplanted hearts located on left and right sides, respectively. An alternative is the heterotopic heart transplant hht, in which the recipient heart and its innervation remain intact and the donor heart is placed in. Serial transaxial pet images from a patient after heterotopic heart transplantation. Although orthotopic heart transplantationisalmost exclusively used worldwide, hhtx may still represent a viable alternative to heart lung transplantation for the growing key teaching points interpretation of heterotopic transplant.
Heterotopic heart transplant is a kind of cardiac grafting that allows. In orthotopic cardiac transplantation, the recipients heart is removed and replaced with a donor heart. A technique less commonly used is the heterotopic procedure, where the donor heart is placed in the chest along with the patients native heart to assist the native heart s function. Heterotopic heart transplantation is performed in 60 spraguedawley sd rats 350400 g. Potential of heterotopic cardiac transplantation in mice as a model for elucidating mechanisms of graft rejection 129 guarantee both the most comfortable examination for the transplanted mouse and the complete and comprehensive acquisition of acute and chronic rejection. Performed first in a human being by barnard in 1974 1, 2, this surgical technique was a useful approach during the precyclosporin era as it reduced early patient death caused by the high rate of graft failure. In endstage hf patients, there are no curative treatment alternatives to heart transplantation that substantially improve survival. The more common orthotopic procedure involves a median sternotomy with removal of the recipients heart and the insertion of the donor heart in the normal anatomic position. Late donor cardiectomy after paediatric heterotopic. With the biologic left ventricular assist biolva concept, much as with a left ventricular assist. The orthotopic cardiac transplant oct, in which the recipients heart is removed and replaced by a denervated donor heart, is the commonest.
This technique is the most widely used in the modern era. In the case of rejection and heart dysfunction, rescuing heterotopic heart transplantation hht patients might be challenging because of high panel reactive antibodies pra and availability of donor hearts. An orthotopic heart transplant is a procedure in which the persons native heart is removed and replaced with a donorallograft heart. Synchronised electrical cardioversion of the native heart 200 j resulted in restoration of sinus rhythm with prompt relief of symptoms and amelioration. Performed first in a human being by barnard in 1974, this surgical technique was a useful approach during the precyclosporin era as it reduced early patient death caused by the high rate of graft. Heterotopic heart transplantation indications, surgical.
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