Orthotopic heart transplantation

Heart transplantation has become the most effective therapy for end-stage congestive heart failure. Since the first human-to-human transplant in 1967, outcomes have changed from relatively poor to a mean survival of more than 11 years, according to data reported in 2012. These improved outcomes and increased numbers of patients receiving orthotopic heart transplants are due to multiple reasons, including changes in immunosuppressive drugs, better management of heart failure patients on the waiting list, increasing use of ventricular assist devices (VADs) as bridge support, improved VAD technology, and improved donor organ preservation. Much of this chapter focuses on details of the orthotopic transplantation procedure itself. Other sections describe the steps involved in accepting transplant recipients and potential contraindications and how patients are prepared for the transplant. Criteria for donor acceptance are also described, as is the critical nature of the target time frame from donor heart availability to transplant, how a donor heart is checked for viability, considerations of posttransplant care including management of immunosuppressive agents, and monitoring for various types of potential rejection and how to treat them.