Heterotopic heart transplantation and native heart ventricular arrhythmias

doi:10.1016/0003-4975(91)91025-Q

The Annals of Thoracic Surgery

Volume 51, Issue 6, June 1991, Pages 987-991

https://doi.org/10.1016/0003-4975(91)91025-Q Get rights and content

Abstract

Heterotopic heart transplantation has been said to be contraindicated in patients with serious native heart arrhythmias that produce hemodynamic instability. Placement of heterotopic allografts, however, can theoretically act as a biological biventricular assist device to provide hemodynamic support during these unstable rhythms. Further, this operation might beneficially alter the hemodynamic milieu of heart failure such that the arrhythmias are ameliorated. Described is our experience with 4 patients with heart failure receiving heterotopic cardiac allografts, documenting changes in native heart arrhythmia that occurred. These cases demonstrate that heterotopic grafts can adequately sustain hemodynamics during malignant native heart dysrhythmia. We believe native heart ventricular arrhythmias are not a contraindication to heterotopic heart transplantation.

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Citation Excerpt :
After this surgical procedure, the donor heart may function as a total or partial biventricular assistance device. Few reports exist about the diagnosis and clinical and therapeutic implications of ventricular dysrhythmias in heterotopic heart transplant recipients.2-6 Ventricular dysrhythmias of the native heart are described to disappear completely or to decrease in frequency after heterotopic heart transplants.6
Native heart complications after heterotopic heart transplantation: Insight into the potential risk of left ventricular assist device
1999, Journal of Heart and Lung Transplantation
Background: In heterotopic heart transplantation, the donor heart is connected parallel to the recipient’s diseased heart. Recipients continue to have risks, such as arrhythmia, thromboembolism, valvular heart disease, and ischemic heart disease which can develop in the native heart. It may serve as a clinical model to study long-term pathophysiologic processes in the native heart of patients with a left ventricular assist device.
We analyzed the prevalence of long-term complications related to the native heart in the heterotopic heart transplant and attempted to gain insight into the potential risk to a native heart after receiving a left ventricular assist device.
Between December 1984 and December 1994, 16 patients (13 men, 3 women, ranging in age from 37 to 60 years) underwent heterotopic heart transplant at the University of Pittsburgh. The 1- and 5-year survival rate after the transplant was 81% and 44%, respectively. Actuarial freedom from complications related to the native heart after 1 year and 4 years was ventricular arrhythmia: 85%, 75%; ischemic disease: 85%, 64%; valvular disease: 100%, 88%; and thromboembolism: 85%, 58%. Of these complications, thromboembolism was not considered in determining actuarial freedom from complications because thromboembolism should be regarded as a device-related complication rather than as a native-heart–related complication for left ventricular assist device recipients. Consequently, actuarial freedom from all complications excluding thromboembolism was 70% after 1 year and 50% after 4 years. In addition, the hazard function curve remains constant up to 80 months after the operation without significant differences among the yearly ratios.
This analysis suggests that cautious observation of the native heart’s long-term performance is necessary for the left ventricular assist device recipient.
Successful treatment of aortic dissection after heterotopic heart transplantation
1995, Annals of Thoracic Surgery
Heterotopic heart transplantation is a valid option when there is a large donor—recipient size mismatch. However, the presence of the diseased native heart can jeopardize the medium-term and long-term outcome. The problems stemming from this most commonly described in the literature are thromboembolism, angina, and arrhythmias. In this report, we describe the case of a type A aortic dissection in the native aorta that occurred 30 months after heterotopic heart transplantation and the surgical technique successfully applied for its repair. We also discuss some of the alternative techniques.
Task force 4: Function of the heart trnsplant recipient
1993, Journal of the American College of Cardiology
Heterotopic heart transplantation and recipient heart operation in ischemic heart disease
1992, The Annals of Thoracic Surgery
The role of heterotopic heart transplantation in coronary heart disease has not been defined. Between 1983 and 1988, 28 patients with end-stage ischemic heart disease were managed by heterotopic heart transplantation and adjunctive operation on the recipient heart: coronary artery bypass grafts and aneurysmectomy, 20; coronary artery bypass grafts, 5; and aneurysmectomy, 3. Indications were feasibility of operative procedures to the recipient heart and small donor size (61% of the donors were < 15 years). The 1-year and 5-year actuarial survival was 79% and 63%. Of the 22 patients who survived to 2-year follow-up, all of whom had been severely limited (New York Heart Association grade III/IV) preoperatively, 20 were in grades I or II at 2-year follow-up (p < 0.001). In 14 of 22 patients (64%), the recipient heart augmented the donor cardiac output substantially, and in 4 the recipient heart supported the patient when the donor heart failed to eject. In conclusion, this series demonstrates the efficacy of heterotopic transplantation combined with operation to the recipient heart in the management of patients with end-stage ischemic heart disease.

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^☆: Preparation of the manuscript was supported, in part, by the Cullen Trust for Health Care and the Alkek Transplant Research Fund.

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Original articleHeterotopic heart transplantation and native heart ventricular arrhythmias☆

Abstract

J Heart Transplant

Am J Cardiol

J Thorac Cardiovasc Surg

J Thorac Cardiovasc Surg

The need for and supply of donor hearts for transplantation

Heart Transplant

Heart replacement for terminal cardiac disease: cardiac transplantation and mechanical sustenance of the cardiovascular system

Baylor Cardiology Series

Heart replacement for terminal cardiac disease: cardiac transplantation and mechanical sustenance of the cardiovascular system

Baylor Cardiology Series

Selection of patients for cardiac transplantation

Circulation

Original article
Heterotopic heart transplantation and native heart ventricular arrhythmias☆