Stanford cardiac transplantation. A review

The cardiac transplantation experience at Stanford University School of Medicine commenced in 1959 with the development of a comprehensive surgical method for successful orthotopic cardiac transplantation in experimental animals. The steps involved included atrial level transection and anastomosis, local myocardial hypothermia and cardiopulmonary bypass. From the first Stanford clinical case in January 1968 until May 1974, 73 transplants have been carried out in 71 patients. Cardiac transplantation is indicated in myopathic disease of an advanced nature with the prospect of imminent death. Contraindications are high pulmonary vascular resistance and intercurrent infection. Relative contraindications are advanced age and insulin-dependent diabetes. Previous cardiac surgery procedures are not contraindications to transplantation. Maintenance immunosuppression requires azathioprine and prednisone indefinitely. Antithymocyte globulin is used for a short time in the postoperative period. Anticoagulants and antiplatelet agents are also used. Therapy for rejection crises includes methylprednisolone, in gram amounts, and actinomycin D. The diagnosis of graft rejection is based on a decrease in electrocardiographic voltage, transvenous endomyocardial biopsy and clinical examination of the patient. The overall survival rate is 43% at one year and 39% at two years. The longest-living survivor in the series is doing a regular day's work five years after transplantation.