Abstract
On the third of december 1967 the first human heart transplantation was performed.
During the last decades the evolution of clinical heart transplantation went from
a hazardous adventure towards a safe and very successful treatment for end-stage heart
failure patients. The major limiting factor is the shortage of donor organs. Patients
with end-stage heart failure without any treatment options for conventional heart
surgery or medical treatment are suitable candidates for heart transplantation. The
major contraindication is a refractory pulmonary hypertension with a high risk for
postoperative right heart failure. Due to the lack of donor organs, there is an age
limitation above 65 years for the acceptance of patients in the majority of transplant
centers. The distribution of donor organs is regulated by the german transplant law
with eurotransplant as the executive organization. Within an acceptable cold ischemic
time of 4 hours, harvesting of the donor organ, transportation and implantation of
the heart has to be done. The implantation technique was developed by R. Lower and
N. Shumway. In some centers, the more advanced total orthotopic heart transplantation
is the technique of choice with a reduced risk of AV-valve incompetence. Postoperative
treatment is very similar to standard heart surgery patients. The major difference
is the immunosuppressive treatment. A balance between the risk of rejection and the
risk of infection due to over immunosuppression requires an individual monitoring
and tailoring of the medication. Despite the risk of heart transplantation, long term
survival with one year survival greater 80 percent and 5 year survival greater than
60 percent in this particular patient group is excellent. Besides survival, quality
of live and exercise capability is well restored after heart transplantation.
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Prof. Dr. Falk-Udo Sack
Klinik für Herzchirurgie
Im Neuenheimer Feld 110
69120 Heidelberg
eMail: falk-udo.sack@urz.uni-heidelberg.de
