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Heart transplants: need versus availability
M Salik Jahania1, Robert M Mentzer
1Division of Cardiothoracic Surgery, Department of Surgery, University of Kentucky College of Medicine, Lexington, Kentucky, USA. sjahani@uky.edu
Insights
Heart failure causes significant deaths and economic burden in the US. Advances in vascular anastomosis, cardiopulmonary bypass, and transplantation techniques have improved treatment, but immunosuppression remains key for long-term survival.
Area of Science:
- Cardiovascular Medicine
- Surgical Innovation
- Transplantation Immunology
Background:
- Heart failure is a leading cause of death in the US, with high mortality and significant economic impact.
- Advanced heart failure survival rates are below 50% within two years.
- The economic burden of heart failure is substantial, costing billions annually.
Purpose of the Study:
- To review the historical advancements in heart failure treatment.
- To highlight key pioneers and their contributions to cardiovascular surgery and transplantation.
- To underscore the importance of immunosuppressive techniques in improving long-term transplant outcomes.
Main Methods:
- Historical review of significant contributions to heart failure treatment.
- Examination of pioneering work in vascular anastomosis and cardiopulmonary bypass.
- Analysis of early heart transplant procedures and xenotransplantation attempts.
Main Results:
- Early surgical innovations like vascular anastomosis and cardiopulmonary bypass laid groundwork for advanced treatments.
- Pioneering heart transplant procedures in animal models and humans demonstrated feasibility.
- Initial human transplants showed limited long-term survival, necessitating further research.
Conclusions:
- The evolution of heart failure treatment is marked by significant surgical and technological milestones.
- Key figures like Carrel, Gibbon, Shumway, and Barnard were instrumental in advancing cardiovascular interventions.
- Progress in immunosuppressive therapies is critical for improving long-term survival in heart transplant recipients.
Abstract:
Every year in the US heart failure accounts for roughly 60,000 deaths and is the contributing cause in another 300,000 deaths. The two-year survival rate for patients with advanced heart failure is less than 50%, with the incidence of death at 106 in 100,000, more than that for AIDS and breast cancer combined. As these figures attest, the economic burden is quite extensive. The Centers for Medicaid and Medicare estimate a cost of $10 billion a year for this diagnosis alone. Both the human and financial cost have impelled doctors and researchers to improve their capacity to treat heart failure both through conventional methods and, in the most serious cases, through transplantation. Many pioneers have either directly or indirectly contributed to our ability to treat heart failure. Among these early researchers were: Dr Alexis Carrel, who was awarded the Nobel Prize for his pioneering work in vascular anastomosis; Dr John Gibbon, who did important work in the development of the cardiopulmonary bypass machine; Drs Normal Shumway, Richard Lower, and Demikhov, who developed heart transplant procedures in the canine model; Dr Christian Barnaard, who performed the first technically successful human-to-human heart transplant (1967); and Dr Thomas Hardy, who attempted the first xenotransplant (1963). While these achievements were phenomenal advances, long-term survival for transplant recipients was minimal until progress was made in immunosuppressive techniques.