Updates in heart transplantation

Area of Science:

• Cardiology
• Transplantation Surgery
• Immunology

Background:

• Heart transplantation (HTx) is a life-saving treatment for end-stage heart failure.
• Mechanical circulatory support and advanced immunosuppression strategies are crucial for patient management.
• Optimizing donor organ utilization is essential to address organ shortages.

Purpose of the Study:

• To evaluate the long-term outcomes of heart transplantation using a specific immunosuppression protocol.
• To assess the efficacy of using suboptimal donor hearts to expand the donor pool.
• To analyze the results of the biatrial anastomotic technique in heart transplantation.

Main Methods:

• Retrospective analysis of 288 heart transplantations performed since 1987.
• Utilized anti-thymocyte globulin (ATG) for induction and low-dose immunosuppressants for maintenance.
• Employed the standard biatrial anastomotic technique, including cases with suboptimal donor hearts and 14-day total artificial heart (TAH) bridging.

Main Results:

• Actuarial survival rates at 1, 5, and 10 years were 86%, 76%, and 61%, respectively.
• Demonstrated satisfactory outcomes with suboptimal donor hearts and successful combined heart-kidney transplant with TAH bridging.
• Observed no increased incidence of tricuspid regurgitation or conduction disturbances compared to the bicaval technique.

Conclusions:

• Low-dose immunosuppressive therapy combined with the biatrial technique yields satisfactory short- and long-term results in heart transplantation.
• The use of suboptimal donor hearts can expand the donor pool and improve patient survival.
• The biatrial anastomosis technique remains a reliable surgical approach for heart transplantation.