Heterotopic heart transplantation in three patients at the Texas Heart Institute
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Implantation of Total Artificial Heart in Congenital Heart Disease
Published on: July 18, 2014
O H Frazier1, J Okereke, D A Cooley
1Division of Surgery and the Transplantation Unit, Texas Heart Institute and St. Luke's Episcopal Hospital, Houston, Texas 77225, USA.
Insights
Heterotopic heart transplantation offers a viable option for critically ill patients awaiting suitable donors. This procedure, while not for all, can be life-saving in end-stage cardiac failure cases.
Area of Science:
- Cardiology
- Transplantation Surgery
Background:
- End-stage cardiac failure presents significant challenges for patients awaiting heart transplantation.
- Orthotopic heart transplantation is the standard, but donor availability can be a limiting factor.
Purpose of the Study:
- To describe the procedure and outcomes of heterotopic heart transplantation.
- To evaluate the efficacy of heterotopic heart transplantation in critically ill patients.
Main Methods:
- Three heterotopic heart transplantations were performed on patients in critical condition due to lack of suitable donors.
- Smaller or mismatched donor hearts were utilized in these procedures.
Main Results:
- All three patients who underwent heterotopic transplantation are currently well and functioning normally.
- The procedure provided a life-saving intervention for patients with end-stage cardiac failure.
Conclusions:
- Heterotopic heart transplantation has a definite place in selected patients with end-stage cardiac failure.
- While orthotopic transplantation remains the primary option, heterotopic transplantation serves as a crucial alternative when necessary.
Abstract:
Seventy-three orthotopic and three heterotopic transplantations have been done in our institution, and in this report, we describe the procedure and outcome of those who underwent heterotopic transplantation. Three patients were in critical condition while awaiting donors for heart transplantation, and in each case, a suitable donor could not be found. Smaller donor hearts became available, and knowing that these patients would die without some kind of immediate action, we performed heterotopic heart transplantations. Patient Number 1 was a 53-year-old diabetic man who was in the last stages of heart disease when a small donor heart became available. Because of his rapidly deteriorating condition, we did a heterotopic transplantation. The patient is presently well and functioning normally. Patient Number 2 was a 26-year-old woman who received the heart of a 13-year-old donor after it became obvious that she could not wait for a suitable donor. We performed a heterotopic transplantation, after which the patient continues to function well. Patient Number 3 was a 53-year-old man who weighed 260 lbs. When a suitable donor could not be found, the heart of a 170-lb man became available and was used in a heterotopic transplantation. This patient also continues to be active and well. After considering the various advantages and disadvantages of heterotopic transplantation, we are convinced that there is a definite place for this procedure in some patients with end-stage cardiac failure, although we still believe that orthotopic transplantation should be offered to most recipients.
