Back to Blog
To heart 2 adult download5/7/2023 Table 64-1 Recipient Selection for Heart Transplantation INDICATIONS Heart transplantation is now a widely accepted therapeutic option for end-stage cardiac failure however, the annual number of transplants in the United States (approximately 2200 per year) has remained relatively constant over the last decade because of limited donor-organ availability (from United Network for Organ Sharing data, through September 2009). Ultimately, however, it was the advent of the immunosuppressive agent cyclosporine that dramatically increased patient survival and marked the beginning of the modern era of successful cardiac transplantation in 1981. The introduction of transvenous endomyocardial biopsy by Philip Caves in 1973 finally provided a reliable means for monitoring allograft rejection. The pioneering efforts of Shumway and colleagues at Stanford eventually paved the way for the reemergence of cardiac transplantation in the late 1970s. Over the next several years, poor early clinical results led to a moratorium on heart transplantation, with only the most dedicated centers continuing experimental and clinical work in the field. Despite great skepticism that cardiac transplantation ever would be performed successfully in humans, South African Christiaan Barnard surprised the world when he performed the first human-to-human heart transplant on December 3, 1967. Although the procedure using Shumway's technique was technically satisfactory, the primate heart was unable to maintain the recipient's circulatory load and the patient succumbed several hours postoperatively. The first human cardiac transplant was a chimpanzee xenograft performed at the University of Mississippi by James Hardy in 1964. 64-1) and Richard Lower at Stanford University to further explore orthotopic heart transplantation using a canine model in 1960. The use of moderate hypothermia, cardiopulmonary bypass, and an atrial cuff anastomotic technique permitted Norman Shumway ( Fig. He later demonstrated that heart-lung and isolated lung transplantation also were technically feasible. In 1946, after unsuccessful attempts in the inguinal region, Vladimir Demikhov of the Soviet Union successfully implanted the first intrathoracic heterotopic heart allograft. Mann also proposed the concept of cardiac allograft rejection, in which biologic incompatibility between donor and recipient was manifested as a leukocytic infiltration of the rejecting myocardium. The neck became the preferred site of implantation in early experimental animal models because of the ease of monitoring the organ, the simplicity of access to major vessels, and because the recipient's native heart could serve as a built-in cardiac assist device for the transplanted organ. Frank Mann at the Mayo Clinic further explored the idea of heterotopic heart transplantation in the 1930s. The innovative French surgeon Alexis Carrel performed the first heterotopic canine heart transplant with Charles Guthrie in 1905.
0 Comments
Read More
Leave a Reply. |