Heart-lung transplantation: lessons learned and future hopes

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Transplantation Immunology

Background:

• Cardiopulmonary transplantation is a complex procedure with significant challenges.
• Early outcomes data are crucial for refining surgical techniques and patient selection.

Purpose of the Study:

• To report the early and late outcomes of 33 consecutive cardiopulmonary transplantations.
• To identify factors influencing patient survival and complications.

Main Methods:

• Review of 33 cardiopulmonary transplant cases performed since March 1982.
• Evaluation of ex vivo heart-lung bloc preservation techniques, including autoperfusion.
• Analysis of complications such as infection, tracheal anastomosis dehiscence, and lung rejection.

Main Results:

• Nineteen of 33 patients were discharged; 16 are doing well.
• Survival rates include 8 at 1 year, 5 at 2 years, and 1 at 3 years.
• Infection was the cause of all 10 deaths; prior sternotomy precluded survival.
• Autoperfusion is the preferred method for distant organ procurement.
• Lung rejection is managed with methylprednisolone; survivors show mild restrictive lung disorder.

Conclusions:

• Candidate selection is paramount for successful cardiopulmonary transplantation.
• Infection remains a major cause of mortality, necessitating improved prophylactic and therapeutic strategies.
• While challenging, ongoing experience with cardiopulmonary transplantation is improving outcomes for future recipients.