Theoretically, a heart transplant was justified before other organs as well as the termination of cardiac blood flow in any case, it was considered the most obvious cause and a sign of death.
A significant step forward was the development of the concept of death based on the detection of brain death, allowing the fence of donor organs in a beating heart. Heart transplantation is shown in end-stage heart failure, provided that no other medical or surgical methods of treatment are ineffective and unviable.
When deciding on a heart transplant is necessary to solve the following tasks:
Make sure that the exhausted conventional treatments;
Clarify whether reversible dysfunction of other organs in the recovery of normal cardiac activity;
Identify changes in the body, which may be exacerbated by immunosuppressive therapy after surgery;
To stabilize the patient and prevent development of fatal complications in up to transplant stage.
The inclusion of patients in the waiting list is in the progression of heart failure and prognosis of death within the next few months. There are two degrees of urgency operation: at first the patient hospitalized for intensive treatment and, possibly, artificial replacement of heart function. The operation of these patients is performed in the first place. In the second degree urgency patients awaiting surgery at home.
Contraindication for heart transplantation is the presence of tumors, severe insulin-dependent diabetes, irreversible lesions of the liver and kidneys, accompanied by their failure, severe peripheral vascular disease, severe psychiatric disease, gastric ulcers and duodenal ulcers, alcoholism, drug addiction.
Ideal for a heart transplant is 60 years younger than the donor, who had in the past, heart disease.
Heart transplantation is performed only in the departments of cardiac surgery with expertise of cardiopulmonary bypass, where there is adequate equipment and qualified personnel.
After dissection of the sternum and opening the pericardium, heart examination is performed. It must be nice and symmetrical fall, do not show any evidence of injuries and diseases of the coronary arteries. From the operating room the patient is transferred to the intensive care unit, which continues monitor monitor vital body functions.
The most frequent postoperative complications are rejection, cardiac arrhythmias and conduction disease, side effects of immunosuppression.
After discharge the patient from the hospital by its translation into supporting the regime of immunosuppression. This person will receive treatment for life to prevent rejection.
To date, a one-year survival of patients after heart transplantation is 85% over 5 years and 70% over 10 years -34%.