The experience of 70 heart transplants in a multidisciplinary medical care facility

Introduction. The total number of patients with chronic heart failure in Russia had reached 15 million by 2016, including 6 million of those with the end-stage heart failure. Currently, heart transplantation (HT) provides the only possible method of a definite treatment of the disease, which allows a significant steady and long-term improvement of patient's quality of life.  The purpose of this article was to review the experience of heart transplantation in a multidisciplinary medical institution over an 8-year period.

Material and methods. Since September 2009, more than 300 patients have been studied for the presence of indications for heart transplantation in the Department of Urgent Cardiology, Assisted Circulation and Heart Transplantation of the Sklifosovsky Research Institute for Emergency Medicine. Eighty of all the screened potential recipients were included in the waiting list, and by the end of 2017, heart transplantations had been performed in 70 of them; the mean waiting time for transplantation was 93 ± 79 days.

Results. The graft ischemia time averaged 174 ± 28 minutes (97 to 250 minutes). The graft ischemia time was 187 ± 36 minutes with the biatrial technique and 169 ± 24 minutes with bicaval technique. That parameter made 184 ± 23 minutes for a distant organ retrieval, while for a local organ retrieval it was 155 ± 29 minutes. By the end of 2017, of 70 cardiac transplant recipients enrolled in the analyzed group, 31 patients (44%) had died, 12 of whom during their hospital stay (hospital mortality was 18%). The main cause of death was the multiple organ failure syndrome in the early postoperative period, and infectious complications in the later period.

Conclusion. The advantage of establishing the organ transplantation center (particularly for heart transplantation) in a multidisciplinary medical care facility lies in reduced donor organ ischemia time and starting treatment of complications without delay. The number of infectious complications, as well as complications associated with acute cellular rejection and coronary artery disease of the transplanted heart can be reduced by creating a regional system ensuring the targeted work with post transplant patients. 

1. Zhang X., Schulz B.L., Punyaeera C. The current status of heart failure diagnostic biomarkers. Expert Rev Mol Diagn. 2016;16(4):487–500. PMID:26788983 DOI:10.1586/14737159.2016.1144474

2. Crespo Leiro M.G., Paniagua Martín M.J. Management of advanced or refractory heart failure. Rev Esp Cardiol. 2004;57(9):869–883. PMID:15373993

3. Clinical recommendations. Chronic heart failure (CHF). 2016. Society of specialists in heart failure, Russian Cardiology Society. Available at: http://www.ossn.ru/upload/medialibrary/003/%D0%A0%D0%B5%D0%BA%D0%BE%D0%BC%D0%B5%D0%BD%D0%B4%D0%B0%D1%86%D0%B8%D0%B8%D0%9E%D0%A1%D0%A1%D0%9D_%D0%9C %D0%97_30012017.pdf (In Russian).

4. Mareev V.Yu., Ageev F.T., Arutyunov G.P., et al. National recommendations of SSHF, RCS and RSMSP on diagnosis and treatment of CHF (fourth revision). Russian Heart Failure Journal. 2013;14(7):379–472. (In Russian).

5. Kazakov E.N., Kormer A.Ya. Shemakin S.Yu. Selection and preparation of patients for heart transplantation.In: Shumakov V.I., ed. Heart transplantation. guide for doctors. Moscow: MIA Publ., 2006. 30–45. (In Russian).

6. Roussel J.C., Baron O., Périgaud Ch., et al. Outcome of Heart Transplants 15 to 20 Years Ago: Graft Survival, Posttransplant Morbidity and Risk Factors for Mortality. J Heart Lung Transplant. 2008;27(5):486–493. PMID:18442713 DOI:10.1016/j.healun.2008.01.019

7. Gautier S.V., et al. Russian Transplant Society. Heart transplantation. National Clinical Recommendations. Moscow, 2013. Available at:http://transpl.ru/images/cms/data/pdf/nacional_nye_klinicheskie_rekomendacii_po_transplantacii_serdca.pdf (In Russian)

8. Mehra M.R., Kobashigawa J., Starling R., et al. Listing Criteria for Heart Transplantation: International Society for Heart and Lung Transplantation Guidelines for the Care of Cardiac Transplant Candidates – 2006. J Heart Lung Transplant. 2006;25(9):1024–1042. PMID:16962464 DOI:10.1016/j.healun.2006.06.008

9. Stewart S., Winters G.L., Fishbein M.C., et al. Revision of the 1990 Working Formulation for the Standardization of Nomenclature in the Diagnosis of Heart Rejection. J Heart Lung Transplant. 2005;24(11):1710–1720. PMID:16297770 DOI:10.1016/j.healun.2005.03.019

10. Locali R.F., Matsuoka P.K., Cherbo T., et al. Shouldbiatrial heart transplantation still be performed? A Meta-analysis. 2010;94(6):829–840. PMID:20625642

11. Sievers H.H., Leyh R., Jahnke A., et al. Bicaval versus atrial anastomoses in cardiac transplantation. Right atrial dimension and tricuspid valve function at rest and during exercise up to thirty-six months after transplantation. J Thorac Cardiovasc Surg. 1994;108(4):780–784. PMID:7934116

12. Fiorelli A.I., Abreu Filho S., Santos R., et al. Cardiac transplantation with bicaval anastomosis and prophylactic graft tricuspid annuloplasty. Rev Bras Cir Cardiovasc. 2008;23(1):7–13. PMID:18719822

13. Mehra M.R., Canter C.E., Hannan M.M., et al. The 2016 International Society for Heart Lung Transplantation listing criteria for heart transplantation: A 10-year update. J Heart Lung Transplant. 2016;35(1):1–23. PMID:26776864 DOI:10.1016/j.healun.2015.10.023

14. Arzumanov S.V., et al., ed. S.V. Gautier, Ya.G. Moysyuk. Transplantology. Pharmacotherapy without errors. A guide for doctors. Moscow, 2014. 432 p. (In Russian).