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. 2014 Aug;6(8):1105-9.
doi: 10.3978/j.issn.2072-1439.2014.07.37.

Heart transplantation

Allen Cheng  1 , Mark S Slaughter  1
Affiliations

Heart transplantation

Allen Cheng et al. J Thorac Dis. 2014 Aug.

Abstract

Heart failure remains a major global problem with approximately 6 million individuals suffering from heart failure in the United States alone. The surgical technique of heart transplantation, popularized by Dr. Norman Shumway, has led to its success and currently remains the best treatment options for patients with end-stage. However, with the continued limitation of donor organs and the rapid development of ventricular assist device technology, the number of patients bridged to transplant with mechanical circulatory support has increased significantly. This has created some new technical challenges for heart transplantation. Therefore, it is now important to be familiar with multiple new technical challenges associated with the surgical techniques of heart transplantation with an ultimate goal in reducing donor heart ischemic time, recipient cardiopulmonary bypass time and post-operative complications. In this review, we described our technique of heart transplantation including the timing of the operation, recipient cardiectomy and donor heart implantation.

Keywords: Heart transplantation.

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Figures

Figure 1
Figure 1
(A) A redo-sternotomy in a patient with previous LVAD placement. Rult retractor (Rultract, Cleveland, OH) was used to assist in exposure for the dissection of the left ventricular apex and LVAD. (B) Completion of the dissection with LVAD outflow graft and LVAD driveline exposed. Snares were placed around the SVC and IVC. LVAD, left ventricular assist device; SVC, superior vena cava; IVC, inferior vena caca.
Figure 2
Figure 2
Completion of the recipient cardiectomy with aorta cross-clamped and vena cavae snared. IVC cannulation was done via the right common femoral vein. SVC, superior vena cava; IVC, inferior vena caca.
Figure 3
Figure 3
(A) LVAD driveline was divided and outflow graft was clamped and divided; (B) Recipient heart was resected along with the LVAD. LVAD, left ventricular assist device.
Figure 4
Figure 4
Back table donor heart preparation. The left atrial appendage incision was closed and the left atrial cuff was created. The donor heart was examined for patent ductus ovale, valvular abnormality and congenital anomaly.
Figure 5
Figure 5
An illustration of the recipient mediastinum and the donor heart with the first stitch at the level of the donor left atrial appendage and recipient left superior pulmonary vein. The illustration on the right showed the completion of a bicaval orthotopic heart transplantation. PA, pulmonary artery; PV, pulmonary vein; SVC, superior vena cava; IVC, inferior vena caca.
Figure 6
Figure 6
The donor heart was placed into the recipient left chest after 3-4 stiches was placed in the left atrial cuff at the level of the left superior pulmonary vein (recipient) and left atrial appendage (donor).
Figure 7
Figure 7
The aorta anastomosis. Aortic cross-clamp was removed after the aorta anastomosis.
Figure 8
Figure 8
Completion of the allograft implantation. Aortic root and left ventricular vent were used for de-airing.
See this image and copyright information in PMC

References

    1. Lower RR, Stofer RC, Shumway NE. Homovital transplantation of the heart. J Thorac Cardiovasc Surg 1961;41:196-204 - PubMed
    1. Lower RR, Shumway NE. Studies on orthotopic homotransplantation of the canine heart. Surg Forum 1960;11:18-9 - PubMed
    1. Lower RR, Dong E, Jr, Shumway NE. Long-term survival of cardiac homografts. Surgery 1965;58:110-9 - PubMed
    1. Weiss ES, Nwakanma LU, Russell SB, et al. Outcomes in bicaval versus biatrial techniques in heart transplantation: an analysis of the UNOS database. J Heart Lung Transplant 2008;27:178-83 - PubMed
    1. Milano CA, Shah AS, Van Trigt P, et al. Evaluation of early postoperative results after bicaval versus standard cardiac transplantation and review of the literature. Am Heart J 2000;140:717-21 - PubMed