Heart transplantation is the process of replacing the sick heart that cannot function adequately with a healthy human heart. When a healthy person who has donated an organ dies (donor), organs such as kidney, liver, heart, lung are prepared and transplanted to patients (recipient) who have already decided for organ transplantation.
What is Heart Transplantation?
Heart transplantation, which is applied to patients whose heart cannot perform its normal functions, is performed with a healthy heart taken from a cadaver. The first trials in the 1930s, the heart transplant operations, which were put on hold for a while after the immune system resulted in the rejection of the heart, were successfully performed for the first time in 1967. Since that day, heart transplantation, which has been successfully applied thanks to the developing medical science and technology, has become a hope for life for many people. Finding a suitable donor for heart transplantation, which cannot be applied to some patients, is possible, although difficult, as it is not possible to obtain the heart through a living donor, as in some other organ donations. It is made with a healthy heart taken. The healthy heart required for heart transplantation, which can also be defined as replacing the sick heart with a healthy heart, which has difficulty in performing its normal functions, is taken from people who have undergone brain death. For this procedure, the person who has brain death must have donated his organs before. can be defined as a heart transplant.
Apart from other organ transplants, only the heart of a brain-dead person is used in heart transplantation. Heart transplantation is performed on people who have reached the end stage of heart failure despite all medical treatments and whose average life expectancy is predicted to be 1 year or less. Heart transplantation, which can be applied to heart patients under the age of 65, can also be performed to people over this age under certain conditions. This depends on the person's physical characteristics and general health rather than age.
Heart transplantation is often needed after myocardial infarction, which is caused by the obstruction of coronary vessels, which are defined as the vessels that feed the heart itself, or after a heart attack, which is widely known among the people. In cases that are not intervened in a timely manner after a heart attack, the heart muscle is seriously damaged.
The heart muscle, which is irreversibly damaged, may cause the heart to fail to perform its normal functions. In addition, heart transplantation may be needed in cases of congenital (congenital) or acquired cardiomyopathy, that is, due to different diseases. In the presence of cardiomyopathy, which leads to severe reduction of heart muscle strength, the heart may not function properly. Since heart transplantation cannot be performed with a heart from a living donor, the number of patients waiting for a heart transplant is quite high. In other words, only 10% to 15% of patients waiting for a heart transplant can have a heart transplant.
Which Hospitals Perform Heart Transplantation?
130 health institutions in 32 cities in Turkey, T.C. It is licensed by the Ministry of Health to perform organ transplantation. Heart transplantation was performed in 84 patients in 2019, 162 patients are still waiting in line for heart transplantation.
The National Tissue and Organ Transplant Coordination Center decides to whom the organs of a person who has brain death will be transplanted.
What are the Tests Performed Before and After the Heart Transplant?
The examinations performed before and after the heart transplantation can be listed as follows. Additional examinations are also performed when deemed necessary.
- Electrocardiography (ECG): It is the device in which the electrical activity (rhythm, frequency) of the heart is recorded.
- Echocardiography (ECO): The pump function of the heart, the monitoring of the heart wall It is done to determine the movements, the operation of the valves and the size of the heart chambers.
- Laboratory tests:
- Determination of blood type
- Determination of tissue type
- Investigating the presence of infections such as hepatitis, HIV
- Tests for kidney, liver diseases, anemia, bleeding problems.
- Heart catheterization and angiography (angiography): Inguinal artery In this examination, which is performed by entering the heart through an opaque substance, occlusions in the coronary vessels feeding the heart The pressure of the heart chambers can be measured and the functions of the heart can be determined.
- Peripheral artery doppler test: With this method, occlusions and stenoses in the vessels can be detected.
- Carotid doppler test: The carotid artery (carotid) It is an examination by ultrasonography.
- Abdominal (abdominal) ultrasound: It is checked whether there is a problem in the organs in the abdomen.
- Lung film: It is applied to control whether there is a problem in the lungs.
- Lung function tests: Measures the function and ventilation capacity of the lungs.
- Heart biopsy: It is a method used in the investigation of tissue rejection after heart transplantation. The heart is reached with the help of the wire sent into the vein passing through the groin or neck and samples are taken from the heart tissue. The tissue samples taken are sent to the pathology and it is investigated whether there is tissue rejection and its degree, if any. Heart biopsy is performed for the first time on the 15th day after transplantation. It can be applied an average of 4-6 times in the first year after transplantation. Over the years, the frequency of biopsy decreases.
Who Can Have Heart Transplantation?
Heart transplantation can be applied in case of occlusion of coronary vessels. Although there are many different treatment options for these patients, heart transplantation may be required to treat end-stage coronary artery disease. Narrowing or blockages in the coronary vessels cause damage to the heart muscle. Heart transplantation may be required for the treatment of this disease, which causes the irreversibly damaged heart muscle to fail to perform its normal functions. In the presence of a tumor in the heart, the tumor must be cleared quickly. However, heart transplantation can be performed in selected cases if the disease is advanced. In such cases, a heart transplant may be needed.
In addition, heart transplantation can be performed in cases such as congenital heart anomalies and failure of the previous heart transplantation. If the heart cannot perform its normal functions despite all known treatment methods have been applied to patients with heart failure problems, a heart transplant is performed. cost comes to the fore. In such cases, where the heart cannot maintain its vital functions, survival can only be achieved by heart transplantation.
However, heart transplantation cannot be performed on every patient with heart failure. Some of the conditions required for a heart transplant are as follows:
- The person should not have developed pulmonary hypertension, which is defined as pulmonary hypertension due to heart failure.
- The person should not have an active infection.
- The person should not have an active infection.
- Heart transplantation cannot be performed on people diagnosed with cancer.
- Heart transplantation is not possible in cases of diabetes that causes vascular damage.
- Excessive fat or underweight according to body mass index Heart transplantation cannot be performed on people with heart disease.
- Heart transplantation is not appropriate in cases where dysfunctions in different organs do not respond to drug treatment.
- Heart transplantation cannot be performed in the presence of osteoporosis, or in other words, osteoporosis.
- Heart transplantation is not suitable for people with psychiatric disorders.
- Heart transplantation cannot be performed for people with alcohol and/or drug addiction.
- The person who is eligible for a heart transplant,
What is the Heart Transplant Waiting List?
After it is determined that the person needs a heart transplant, the patient is taken to the council. Many issues such as the person's entire medical history, treatments and stages, recent examinations, and physical capacity are handled by the council. After this examination, which is a preliminary evaluation, the general condition of the patient is evaluated in detail by the board. With a multidisciplinary approach, opinions from many different branches are taken and additional examinations are performed. If it is decided that the patient is suitable for a heart transplant, the person is included in the heart transplant program.
Ministry of Health National Organ and Tissue Transplantation Coordination Center (UKM) in case of finding a suitable heart for the person in the program, the coordinator sends all the information to the physician who will perform the heart transplant operation. Patients and their relatives are informed. If all parties approve the heart transplant, the person's pre-operative preparations are started.
What is Artificial Heart Support System?
Artificial heart support systems are a good choice in emergencies. They are devices that replace the heart for three days or a few weeks and perform the pumping function, and systems such as ventricular (cardiac ventricle) support devices and total artificial hearts that will take on the task of pumping blood for years.
“Ventricle Support Devices” is the most commonly used artificial heart support system in the world because it can provide support for many years and can be placed with a shorter surgery compared to the artificial heart. These devices, which are placed inside the rib cage, right next to the heart, increase blood circulation in the body by working with the heart. In this way, it is ensured that all organs in the body are adequately nourished. These devices are connected to batteries placed in a bag that can be carried on the back or shoulder with a thin cable that is taken out of the body, and they get their energy from there. It also increases the blood flow to the tissues.
Detailed information about artificial heart support devices. What is Artificial Heart Devices?
When to Use Heart Transplantation and When to Use Artificial Heart Support System?
Approximately 5000 heart transplants are performed every year in the world. In our country, the number of heart transplants has increased regularly since 1996, approaching 100 per year. However, the number of patients waiting for a heart is much higher than the number of patients who can still have a heart transplant. Now, patients with end-stage heart failure can be treated with ventricular assist devices and patients have a chance to live longer and better and/or until heart transplantation.
How is Heart Transplant Performed?
After the necessary examinations of the person to be transplanted, the person is taken to the operating room. Before the transplant procedure begins, the patient is connected to the heart-lung device. Thus, the continuity of the person's vital functions is ensured. Heart transplant surgery takes an average of 5-6 hours if no complications develop.
Patients whose surgery is completed are taken to the special transport room in the cardiac surgery intensive care unit. Patients 8 to 2
Read: 0
