The first heart transplants were done in the late 1960s. But not until anti-rejection medicines were put into use in the 1980s, did the procedure become accepted. Today, heart transplantation gives hope to a select group of patients who would otherwise die of heart failure.
The two most common heart problems that lead to heart transplantation are:
- Idiopathic cardiomyopathy, a disease of the heart muscle where the cause is unknown, and
- Coronary artery disease, in which plaque has built up and blocked the arteries that feed the heart with oxygen-rich blood.
As these conditions weaken the heart muscle, it is less able to pump blood to the rest of the body. The heart tries to compensate for this weakness by enlarging (becoming hypertrophied). In time, the heart works so hard it may wear out, overcome by disease and become less able to meet even the smallest pumping demands. Medicines, mechanical devices and other therapies can sometimes help and even improve a patient's condition. But when those treatments fail, transplantation becomes the only option.
The Cedars-Sinai Heart Transplantation Program provides comprehensive treatment and surgical care tailored to each patient's needs. Following transplantation, the program provides detailed follow-up care that includes endomycardial biopsies (taking tissue samples from your new heart to make sure that your body isn't rejecting it) and managing immunosuppressive therapy.
Cedars-Sinai monitors patients after transplant and records and reports statistics about heart transplant survival rates.
Procedures done include heart transplantation, heart-lung transplantation, left ventricular assist device implantation or automatic implantable cardioverter defibrillator insertion.
The Cedars-Sinai Heart Institute was the first in California to implant the portable artificial heart (TLC-II portable ventricular assist device), which can prolong life while waiting for a donor organ.
Additionally, surgeons at Cedars-Sinai were among the first in the U.S. to use a new technique of heart transplantation, called the bicaval and pulmonary venous anastomotic technique. This technique involves transplantation of the entire donor heart (rather than only part of the donor heart) and is more time-consuming than the standard technique of heart transplantation, requiring greater surgical skill. Nevertheless, the new technique has led to improvements in the function of the transplanted heart, especially in the first few months after surgery. The transplant team's experience with the bicaval technique is one of the most extensive and well known in the world.
Approximately 2,500 heart transplants are done in the United States each year on patients who today range from newborns and children to the elderly. The success of heart transplantation has paved the way for multiple organ transplants such as heart-lung, heart-kidney and heart-liver transplants.
Looking to the future, researchers are working to develop more effective and more specific immune system suppressing drug to fight organ rejection, improved artificial hearts and mechanical assist devices to sustain critically ill patients until transplantation and the potential use of donor organs from other animal species (xenotransplantation).
Even has heart transplantation becomes more effective, the number of donor organs available fails far behind the number of people waiting for a heart to transplant. More and more, the future of organization transplantation rests with increased public awareness of the need for organ donation.
