Procedure to remove a diseased heart and replace it with a healthy one from a legally dead donor. The first was performed in 1967 by Christiaan Barnard. The diseased heart is removed (except for some atrial tissue to preserve nerve connections to the natural pacemaker). The new heart is put in place and connected to the recipient's blood vessels. Patients and donors are matched for tissue type, but the patient's immune system must still be suppressed to prevent rejection (see immunosuppression). A successful transplant can enable the recipient to have an active life for many years.
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A heart-lung transplant is a procedure carried out to replace both heart and lungs in a single operation. Due to a shortage of suitable donors, it is a rare procedure; only about a hundred such transplants are performed each year in the USA.
Conditions which may necessitate a heart-lung transplant include:
Candidates for a heart-lung transplant are usually required to be:
Building on his research at Stanford, Dr. Bruce Reitz performed the first successful heart-lung transplant on Mary Gohlke in 1981 at Stanford Hospital. The transplant team at Stanford is the longest continuously active team performing these transplants.
Once suitable donor organs are present, the surgeon makes an incision starting above and finishing below the sternum, cutting all the way to the bone. The skin edges are retracted to expose the sternum. Using a bone saw, the sternum is cut down the middle. Rib spreaders are inserted in the cut, and spread the ribs to give access to the heart and lungs of the patient.
The patient is connected to a heart-lung machine, which circulates and oxygenates blood. The surgeon removes the failing heart and lungs. Most surgeons endeavour to cut blood vessels as close as possible to the heart to leave room for trimming, especially if the donor heart is of a different size than the original organ.
The donor heart and lungs are positioned and sewn into place. As the donor organs warm up to body temperature, the lungs begin to inflate. The heart may fibrillate at first - this occurs because the cardiac muscle fibres are not contracting synchronously. Internal paddles can be used to apply a small electric shock to the heart to restore proper rhythm.
Once the donor organs are functioning normally, the heart-lung machine is withdrawn, and the chest is closed.
This means that three years after the transplant, nearly half of the recipients have died. These statistics compare very unfavorably with other organ transplants, such as kidney transplants.
2,000 Transplants and Counting: University of California at Los Angeles's Heart Transplant Program Reaches Major Milestone
Jun 29, 2012; LOS ANGELES, June 27 -- The University of California at Los Angeles issued the following press release: The UCLA Heart Transplant...