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10 Indications for Heart Transplantation

Some complex congenital heart diseases are not amenable to surgical correction or repair and require neonatal heart transplantation. However, many conditions can be corrected or repaired in childhood and over 80 per cent of patients with CHD now survive to adulthood.

Over five decades, since the first successful heart transplant was carried out by Christiaan Barnard in Cape Town, South Africa, this procedure remains the most effective proven therapy to alleviate symptoms, improve quality of life and confer survival benefit for a selection of end-stage heart failure (HF) patients who have no further medical or non-transplant surgical options available to them. Typically, these patients will have less than 50 percent chance of surviving the next two years without the surgical intervention.

The following are indications for heart transplantation:

Idiopathic Dilated Cardiomyopathy:  This is a disease of unknown cause that affects the heart muscle such that one or both ventricles, or main pumping chambers of the heart, tend to dilate and cause reduced function, The heart is then unable to pump sufficient blood around the body, particularly when it demands more oxygen and nutrients during exertion.

Ischaemic Cardiomyopathy:  This is caused by disease of the arteries of the heart  whereby the arteries are either narrowed or blocked by local deposition and collection of fatty material through  a process called atherosclerosis. Many patients will have had intervention by way of stents placed inside the diseased arteries, or have had bypass surgery. Some patients with ischaemic heart disease can also have refractory chest pain, or angina, that is not amenable to percutaneous or surgical treatment. They also benefit from heart transplantation.

Valvular Heart Disease:  A condition where disease of one or more heart valves leads to damage of the heart muscle with enlargement of the heart and poor function.

Hypertrophic cardiomyopathy:  Characterised by abnormal thickening of the heart muscle, typically the left ventricle, such that it becomes stiff and unable to perform the necessary pumping action. This condition is often linked to an inherited  genetic defect.

Infiltrative cardiomyopathy:   Both genetic and acquired causes lead to the deposition of abnormal material within the tissues of the heart leading to heart failure. Some of these diseases are Amyloidosis, Sarcoidosis, Haemochromatosis, Fabry disease, Danon disease and Friedreich’s ataxia.

Congenital Heart Disease (CHD):   Some complex congenital heart diseases are not amenable to surgical correction or repair and require neonatal heart transplantation. However, many conditions can be corrected or repaired in childhood and over 80 per cent of patients with CHD now survive to adulthood. A proportion of patients who have had one or more surgical procedures will develop heart failure later in life. Some of these conditions will eventually result in damage to the lungs also with the requirement of a combined heart and lung transplant.

Persistent Ventricular Arrhythmia: Intermittent malignant heart rhythms can become intractable with damage to the heart muscle and eventual heart failure.

Primary Cardiac Tumors: Rarely, a primary cardiac cancer without risk of metastasis may also be amenable to heart transplantation.

Other conditions: Heart muscle can also be damaged by alcohol, drugs, viral infection (viral myocarditis), following childbirth (post-partum cardiomyopathy) and also in the context of thyroid disease or Diabetes.

The writer is Dr Kumud Kumar Dhital , Senior Consultant Cardiothoracic Surgeon at Yashoda Hospitals

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