January 29, 2019 No comments

A heart transplant is a procedure whereby a heart is replaced with another heart from a suitable donor. As a rule, it is intended for patients with end-stage congestive heart failure who, according to the prognosis, have less than 1 year of life without a transplant and who are not helped by the use of traditional drug therapy. Aside from this, most transplant candidates cannot undergo other surgical treatment options as a result of poor heart condition.

Candidate identification and evaluation are key components of the process, as are the follow-up and management of immunosuppression. Performing these steps correctly can lead to extremely satisfactory results for both the doctor and the patient.

Heart transplant candidates usually have moderate or severe symptoms. Evaluation shows ejection fractions less than 25%. Attempts are being made to stabilize the condition of the heart during the assessment process.

Intermediate therapy may include oral agents as well as inotropic support. Mechanical support using an intra-aortic balloon pump or implantable assistive devices may be suitable for some patients as a bridge for transplantation. However, mechanical support does not improve survival in adult patients with congenital heart disease.

The annual frequency of heart transplants is about 1% of all people with heart failure. Improved medical management of congestive heart failure has reduced the number of candidates; However, organ availability remains a problem.

Heart transplant is the replacement of a broken heart with the heart of a matching donor. The 1-year survival rate after heart transplantation reaches 81.8%, and the 5-year survival rate is 69.8%. A significant number of recipients survive more than 10 years after the procedure.

Diseases Required for Heart Transplant

Diseases that require a heart transplant can be divided into the following categories:

• Dilated cardiomyopathy (54%) - this is often of unclear origin
• Ischemic cardiomyopathy (45%) - this percentage is growing due to an increase in IHD in younger age groups.
• Congenital heart defects and other diseases not amenable to surgical treatment (1%)

The pathophysiology of cardiomyopathy, which may require cardiac replacement, depends on the underlying disease process. Chronic ischemic conditions accelerate myocardial cell damage with a progressive increase in myocyte, followed by cell death and scarring. The condition can be treated with angioplasty or bypass surgery; however, small vessel disease progresses and thus leads to progressive loss of myocardial tissue. This ultimately leads to significant functional loss and progressive cardiac dilatation.

The pathological process associated with functional deterioration of dilated cardiomyopathy is still unclear. Mechanical dilatation and destruction of energy stores seem to play a role.

The pathophysiology of the transplanted heart is unique. The denervation of an organ makes it dependent on its own speed. As a result of the lack of neuronal input, some hypertrophy of the left ventricle occurs. The function of the right side is directly related to the ischemic time to reimplantation and the adequacy of preservation. The right ventricle is easily damaged and may initially function as a passive canal until recovery occurs.

The process of rejection that can occur in the allograft has 2 primary forms, cellular and humoral. Cellular rejection is a classic form of rejection and is characterized by perivascular infiltration of lymphocytes, followed by myocyte damage and necrosis if left untreated.

Humoral rejection is much more difficult to characterize and diagnose. It is believed to be a generalized antibody response triggered by several unknown factors. The deposition of antibodies in the myocardium leads to general cardiac dysfunction. This diagnosis is usually made on the basis of clinical suspicion and exclusion; Endomyocardial biopsy is of little value in this context.

IHD is a late pathological process characteristic of all allografts of the heart, characterized by myointimal hyperplasia of small and medium vessels. The lesions are diffuse and can appear at any time from 3 months to several years after implantation. The cause of incitement is unclear, although cytomegalovirus (CMV) infection and chronic rejection have been implicated. It is believed that the mechanism of this process depends on the production of growth factors in the allograft, initiated by circulating lymphocytes. There is currently no other treatment other than retransplantation.

The future of heart transplantation will be determined by the results of several questions. One of these is the persistent shortage of donor organs, which has led to the search for alternative treatments for heart failure. These treatments include artificial aid devices, dual chamber stimulation, new drug interventions, and genetic therapy. These efforts have been successful in reducing the need for transplantation. Research in the field of xenografts is ongoing.

Indications for use

Common indications for heart transplant include worsening heart function and a life expectancy of less than 1 year. Specific indications include the following:

• Dilated cardiomyopathy
• Ischemic cardiomyopathy
• Congenital heart defects for which no conventional therapy exists or for which conventional therapy has failed
• Ejection fraction less than 20%
• intractable angina pectoris or malignant heart rhythm disturbances for which traditional therapy has been exhausted
• Pulmonary vascular resistance less than 2 units
• Age under 65
• Ability to comply with medical supervision

Contraindications

Contraindications to heart transplant include the following:

Age over 65 is a relative contraindication; patients over 65 are assessed individually

Fixed pulmonary vascular resistance of more than 4 units

Active systemic infection

Active malignant neoplasm. patients with malignant neoplasms who have a 3-5 year disease-free period may be considered depending on the tumor type and the assessment program.

Current history of substance abuse (such as alcohol, drugs, or tobacco)

Psychosocial instability

Inability to have medical supervision

results

The 1-year survival rate after heart transplantation reaches 81.8%, and the 5-year survival rate is 69.8%. A significant number of recipients survive more than 10 years after the procedure. After transplantation, individuals with congenital heart disease have a high 30-day mortality rate. The functional state of the recipient after the procedure is usually excellent, depending on his or her level of motivation.

In patients with severe biventricular insufficiency who received pneumatic biventricular assistive devices as a bridge for transplantation, the annual actuarial survival rate was 89% compared with 92% in patients without a ventricular assistive device.

Hypertension, diabetes mellitus, and obesity are associated with exponential increases in postoperative mortality rates. It was found that in heart transplant recipients with all three of these metabolic risk factors, mortality increased by 63% compared to patients without any risk factors.

Treatment

The goal of pharmacotherapy is to prevent complications, reduce morbidity and reduce the likelihood of organ rejection.

Immunosuppressants

Immunosuppression begins shortly after surgery. The transplant recipients maintain an immunosuppression regimen that includes 1-3 drugs. Typically, drugs are divided into 3 categories: steroids, antimetabolites, and other immunosuppressants. Several regimens can be used, including pre-transplant induction therapy and simple postoperative supportive therapy; The choice of the regimen depends on the training and experience of the transplant center.

Cyclosporine (Neoral, Sandimmune)

Cyclosporin is a cyclic polypeptide that suppresses some humoral immunity and, to a greater extent, cellular immune responses such as delayed hypersensitivity, allograft rejection, experimental allergic encephalomyelitis, and graft-versus-host disease for various organs.

For children and adults, the basic dosage depends on the ideal body weight. Maintaining appropriate levels of drug in the bloodstream is critical to maintaining the allograft. Food can alter drug levels and timing. Medicines must be taken at the same time every day.

Neoral is a capsule form of cyclosporin available in 25 and 100 mg capsules. Sandimune is a liquid form.

Prednisone

Prednisone is an immunosuppressive drug used to treat autoimmune diseases. It can reduce inflammation by altering increased capillary permeability and inhibiting polymorphonuclear leukocyte activity. It is an oral steroid with approximately 5 times the potency of endogenous steroids. Oral prednisone should be minimal or absent for the first 21 days after transplantation unless rejection occurs.

Methylprednisolone (Medrol, Solu-Medrol, A-Metapred)

Methylprednisolone is an immunosuppressive drug used to treat autoimmune diseases. It can reduce inflammation by altering increased capillary permeability and suppressing PMN activity. This is an intravenous (IV) form of prednisone.

Tacrolimus (Prograf)

Tacrolimus suppresses humoral immunity (T cell activity). It is a calcineurin inhibitor with 2-3 times cyclosporin activity. Tacrolimus can be used in lower doses than cyclosporine, but it has serious side effects including renal dysfunction, diabetes, and pancreatitis. Levels are adjusted based on kidney function, liver function, and side effects.

Mycophenolate mofetil

Mycophenolate mofetil inhibits inosine monophosphate dehydrogenase and suppresses de novo purine synthesis by lymphocytes, thereby suppressing their proliferation. It suppresses the production of antibodies.

Azathioprine (Imuran, Azasan)

Azathioprine counteracts purine metabolism and inhibits the synthesis of DNA, RNA and proteins. This can decrease the proliferation of immune cells, which leads to a decrease in autoimmune activity. Antimetabolites are used to block the absorption of vital nutrients needed by cells. These drugs are supposed to affect not only the cells of the immune system, but also other cells in the body. The effectiveness of therapy depends on the dose. Azathioprine is not effective in acute rejection, but remains an economical choice for long-term immunosuppression.

Sirolimus

Sirolimus, also known as rapamycin, is a macrocyclic lactone produced by Streptomyces hygroscopicus. It is a potent immunosuppressive agent that inhibits the activation and proliferation of T cells in a mechanism different from that of all other immunosuppressive drugs. This inhibition suppresses cytokine-driven T cell proliferation by inhibiting the G1 to S phase transition in the cell cycle.

Inotropic agents

After the procedure, the patient receives a combination of pressor agents while the donor heart replenishes its energy reserves. After stabilization, the patient is quickly weaned from the ventilator and presses. The combination chosen depends on the training and experience of the center.

Dopamine

Dopamine is a naturally occurring endogenous catecholamine that stimulates beta1 and alpha1 adrenergic and dopaminergic receptors in a dose-dependent manner. Stimulates the release of norepinephrine.

In low doses (2-5 μg / kg / min), dopamine acts on dopaminergic receptors in the renal and visceral vascular beds, causing vasodilation in these beds. In moderate doses (5-15 μg / kg / min), it acts on beta-adrenergic receptors, increasing heart rate and contractility. At high doses (15-20 μg / kg / min), it acts on alpha-adrenergic receptors, increasing systemic vascular resistance and increasing blood pressure.

Dobutamine

Dobutamine is a sympathomimetic amine with a stronger beta effect than alpha. Increases inotropic state. Vasopressors increase coronary and cerebral blood flow during a state of weak blood flow associated with severe hypotension.

Dopamine and dobutamine are the drugs of choice for improving cardiac contractility, with dopamine being the drug of choice in patients with hypotension. Higher doses can cause an increase in heart rate, exacerbating myocardial ischemia.

Adrenalin

Its alpha agonistic effects include an increase in peripheral vascular resistance, inverse peripheral vasodilation, systemic hypotension, and vascular permeability. Its beta2-agonistic effects include bronchodilation, chronotropic cardiac activity, and positive inotropic effects.

Norepinephrine (levofed)

Norepinephrine stimulates beta1 and alpha adrenergic receptors, increasing cardiac muscle contractility and heart rate, as well as vasoconstriction; this results in systemic blood pressure and increased coronary blood flow. After receiving a response, the flow rate should be adjusted and maintained at a low normal blood pressure, such as a systolic pressure of 80-100 mmHg, sufficient to perfuse vital organs.

Heart transplant for a child

Heart transplantation in infants and children is currently an accepted therapy. According to the registry of the International Society for Heart and Lung Transplantation, about 500-600 heart transplants are performed in children worldwide every year, which is about 12% of the total number of heart transplants performed. In 2014, 586 heart transplants were performed in children worldwide.

In infants, congenital malformations are still the most common indication for heart transplantation. Congenital cardiomyopathy occurs in about one in 10,000 live births. The most common indication for heart transplantation in older children is cardiomyopathy. The number of children with cardiac disorders at the end after palliative surgery for congenital heart disease is increasing. An important example is the so-called Failure Fountain.

Approximately 10% of cases of congenital heart defects were considered refractory to treatment. One of the most common indications for infant heart transplantation has been hypoplastic left heart syndrome (HLHS), which occurs in about one in 6,000 live births. HLHS has declined as an indicator for heart transplantation due to the limited donor supply and improvements that have been made in surgical palliation (i.e., the Norwood procedure, with or without Sano's modification). See Surgical Treatment of Pediatric Hypoplastic Left Heart Syndrome.Over the past 3 decades, heart transplantation has evolved from the main indication for the treatment of neonates with unrecovered HLHS to the treatment of end-stage heart failure in adolescents and young adults with palliative congenital heart disease.

Infants with severe congenital heart defects are usually present during the neonatal period with varying degrees of cyanosis, tachypnea, tachycardia, dysrhythmia, poor perfusion, food intolerance, and other symptoms of heart failure. Heart failure symptoms, with a fast or slow onset, are associated with cardiomyopathies. Children with heart tumors may have congestive heart failure (CHF) or fainting or cardiac arrest due to arrhythmias. A growing number of congenital lesions are diagnosed with fetal ultrasound.

Survival for 20 years after pediatric heart transplantation has been achieved. Most programs now report that over 70% of their recipients survive for at least 5 years. However, while an extra 5 years of life is important for everyone, the goal of pediatric heart transplants is to ensure the longest possible normal life span for these children.

Donor supply remains insufficient. Raising public and medical awareness of donor issues is the most important factor in increasing donor supply, as many potential donors are not identified as such. Other more innovative and controversial donor sources include resuscitation of asystolic donors and the use of xenografts.

In this article, we will find out how much a heart transplant costs. Transplantation of this organ is a separate field of medicine. It arose at the junction of immunology and cardiology. Immunology is a science that deals with human immunity and is of great importance in matters of rejection and engraftment of a graft (transplanted biomaterial).

The first studies that were carried out in the field of transplantation began in the 50s of the last century. The surgical interventions, which ended successfully, were carried out by doctors in the USA and South Africa in the 80s. In the USSR, the first such operation was carried out by V.I.Shumakov in 1988. Due to the fact that the immunological basis associated with the host-graft reaction was previously insufficiently studied, the duration and quality of life after surgical manipulation did not correspond to the desired results, and the prognosis was uncertain. Read about the cost of heart transplant below.

Currently, the level of knowledge has significantly increased and allows such operations to be carried out with a minimum likelihood of complications. In addition, the life expectancy after heart transplantation is sufficient (slightly less than half of patients after the intervention live more than 10 years).

In some cases, there is the possibility of performing repeated transplants, for example, one of the richest people in the world according to Forbes, D. Rockefeller, had a sixth heart transplant at 99 years old.

Many patients with various pathologies and their relatives are interested in how much a heart transplant costs.

Indications for transplantation

Heart transplantation intervention is the least common operation in the field of cardiac surgery. This is due not only to high financial costs, but also to certain nuances:

1. A limited number of donors are individuals with healthy hearts but confirmed brain death.
2. Long time required for selection of a donor in accordance with waiting lists. This problem is especially relevant in relation to heart transplant operations for a child.
3. An ethical problem, including from the point of view of religion (in particular, according to Christian ideas, a person is considered alive as long as his heart is beating).
4. Short shelf life of the donor organ (up to 6 hours).

But, despite the problems described, the transplantation operation, although very rare, is carried out, and quite successfully. How much does heart transplant surgery cost is important to find out in advance.

The main indication in which a patient needs this operation is the final (terminal) stage of chronic heart failure, or of the third or fourth functional class, which is not amenable to drug therapy, with a survival prognosis of less than a year in this condition.

It is the symptomatology characteristic of the last stage (the onset of shortness of breath at rest, significant swelling of the whole body and limbs, significant limitation of activity), in the absence of the effectiveness of conservative treatment, may require a heart transplant. For many, cost doesn't matter.

Such severe heart failure can occur as a result of the following pathologies:

1. Cardiomyopathy. This disease is a condition in which the myocardial fibers are restructured, replaced by scar tissue, as a result of which the process of contraction and relaxation of the heart muscle is disrupted. Usually CHF develops with ischemic and dilated cardiomyopathy.
2. Acquired or congenital inoperable heart muscle defects.
3. Tumors of the heart.
4. Severe heart rhythm disturbances and uncontrollable angina pectoris, which do not respond to drug treatment and have led to severe cardiac dysfunction.

In addition to the indications listed above, the results of objective research methods (catheterization of the pulmonary artery, ultrasound of the heart) are taken into account:

1. No severe pulmonary hypertension.
2. The fraction of the left ventricular injection is less than 20%.

In addition, when planning an operation, certain conditions must be met:

1. The age of the recipient (the patient who is to have an organ transplant) must be less than 65 years old.
2. The patient's desire to follow a further strict plan of therapy and observation, his diligence.

Requirements for a donor heart

How much does a heart transplant cost is a topical question today. To understand this, you need to understand that an organ donor can be a person who is in a coma, and whose brain death is confirmed, and cardiac activity is supported in the intensive care unit with the help of equipment. As a rule, such severe patients are observed in hospitals after strokes or road accidents. That is, the person is actually already dead, since his heart works with the help of drugs, and he breathes due to the ventilator. If the heart of such a person is transplanted to another person, it will be able to work autonomously in the new organism. To remove an organ from a patient's body, doctors need the consent of the patient himself, drawn up during his lifetime, or his relatives. In the absence of relatives, or if the patient is not identified, his heart can be removed without official documentation.

A commission consisting of several people, including the head physician of the medical institution in which the donor is located, fills out the necessary papers. After that, a specialist from the transplant center arrives, always with an assistant nurse, and performs an operation, during which the donor heart is removed and then placed in a container filled with cardioplegic solution and transported to the center. What determines the cost of a heart transplant in Russia?

Donated hearts are selected according to the following criteria:

1. There are no malignant tumors.
2. There is no viral hepatitis (B, C), HIV infection.
3. The absence of cardiac pathologies, which is confirmed by the results (coronary angiography, ultrasound of the heart, ECG).
4. The blood groups of the recipient and the donor are ABO compatible.
5. The dimensions of the recipient heart and the heart donor are approximate. Evaluation is carried out using ultrasound.

Transplant waiting time

To understand how much a heart transplant costs in Moscow, let's first determine what the terms are. In order for the patient to undergo surgery, a waiting list is drawn up at the transplant center. These centers collaborate with medical institutions in which potential donors can potentially be seen - neurological, trauma and other hospitals. Periodically, the center asks hospitals for information on the availability of possible heart donors, and then compares the list of patients in need of transplantation with the available donors according to the selection criteria listed above. The patient can get a referral to the transplant center from the attending physician - cardiac surgeon or cardiologist.

A lot of time can pass from the moment the waiting list is drawn up. If a suitable donor is never found, then the patient may die due to cardiac insufficiency without waiting for the transplant. If a donor is found, the transplant operation will be performed in the near future.

Since the predicted survival rate of a patient with an indication such as CHF is less than a year, a donor should be found within this critical period.

How much does a heart transplant cost?

Around the world, a law has been passed that prohibits the sale of organs, only related or cadaverous transplantation is allowed. In this regard, the patient receives the heart itself for free. You will only need to pay for the operation itself, medical support before and after transplantation, as well as the rehabilitation period.

So how much does a heart transplant cost in Russia? In general, the price varies and amounts to 70-500 thousand dollars. The average cost of a transplant operation is 250 thousand rubles. In the Russian Federation, there is a possibility of free provision of high-tech types of medical care to citizens, as well as payment for transplant surgery under quotas (according to the compulsory medical insurance system), but in any case, the possibility of free transplantation and its exact cost should be clarified with the attending specialist.

Where is heart transplant done? There is only one coordination center on the territory of Russia, which carries out the selection of donor organs. It operates on the territory of the Moscow region and Moscow. Heart transplants are performed directly in the following medical institutions:

1. Northwestern Federal Medical Research Center named after Almazova V.A. " FGBU located in St. Petersburg.
2. Scientific Research Institute of Circulatory Pathology named after E. N. Meshalkina, located in Novosibirsk.
3. Federal Scientific Center for Transplantology and Artificial Organs V. I. Shumakova, located in Moscow (FGBU "FNTSTIO").

In recent years, the development of transplantation has begun in Chelyabinsk, namely in the Chelyabinsk Regional Clinical Hospital. What is the cost of a heart transplant in Chelyabinsk? The price must be checked at the clinics. But it is not very different from the capital.

In addition, transplantation is carried out in the capital of Belarus - Minsk. That is, the geography of such operations is rapidly expanding. How much does a heart transplant cost in Minsk? Its price is about 70 thousand dollars.

Due to the fact that in Russia the legal norms for organ donation are not fully worked out, heart transplant operations are performed very rarely. For example, during 2014, only 200 such manipulations were carried out, while in the United States during the same period, about 28 thousand transplant operations were performed. In addition, due to the legal prohibition of organ donation from people under 18 years of age, children requiring heart transplants required expensive treatment abroad (India, Germany and Italy). However, in May 2015, a legislative act was adopted on the procedure for establishing cerebral death in patients over 1 year old. This made it possible for the subsequent development of legislation in the field of child donation.

Question: "How much does a heart transplant cost in Germany?" occurs almost immediately after the decision about the operation is made. Prices vary from clinic to clinic. On average, this is 400 thousand euros.

Contraindications to transplantation

Such surgery is contraindicated in the following situations:

1. Severe pulmonary hypertension (presence of high pressure in the pulmonary artery).
2. Severe form of diabetes mellitus, in which there is damage to the retina of the eyes, kidneys, blood vessels.
3. Active tuberculous process, HIV infection.
4. Acute forms of infectious diseases.
5. Severe forms of hepatic and renal failure.
6. Systemic diseases of an autoimmune nature (rheumatoid arthritis, systemic lupus erythematosus, others).
7. Severe chronic obstructive disease.
8. Drug, alcohol addiction.
9. Diseases of an oncological nature.
10. Acute stages of mental illness.

We talked about the cost of heart transplant in Moscow.

The process of preparing for surgery

If a patient is referred to a transplant center and a decision is made to place him on the waiting list for organ transplant, he is assigned a special examination plan. The analyzes required in this case are:

1. Examination by a urologist, gynecologist.
2. Examination by a dentist, otorhinolaryngologist (this is necessary to exclude the presence of chronic infectious foci in the oral cavity and nasopharynx).
3. Examination by a cardiac surgeon.
4. ECG, ultrasound of the heart, CAG (if necessary).
5. General laboratory examination of urine samples.
6. Clinical laboratory examination of blood samples, determination of the blood group, coagulation system.
7. Blood tests for markers of syphilis, viral hepatitis, HIV infection.
8. X-ray examination of the chest cavity organs or fluorography.

For hospitalization in a transplant center for an operation, if a donor is available, the patient must always have copies and originals of the following documentation available:

1. Passport, health insurance policy, SNILS.
2. An extract obtained from the sending institution and containing the results of all examinations carried out.
3. A referral received from a health care facility at the place of registration of the recipient. Information about the cost of heart transplant surgery should be collected.

Transplantation procedure

The heart transplant procedure in Moscow begins with the removal of the donor organ from the body and placing it in a container with cardioplegic solution for no more than 4-6 hours. During this time, preoperative preparation of the recipient is carried out (premedication - sedative and analgesic drugs are administered). Then, in the operating room, using general anesthesia, the recipient is cut through the anterior chest wall, the large vessels are attached to an artificial circulation device (AIC), which will perform the function of an artificial heart during the operation.

Then cut off the left and right ventricles of the heart. At the same time, the atria are preserved. Preserving your own atria allows you to leave active the sinus node, which sets the rhythm of the heartbeat and is the pacemaker.

Thereafter, the donor's atria are sutured to the recipient's atria and a temporary pacemaker is inserted to maintain adequate heart rate after transplantation. The chest is sutured, an aseptic bandage is applied. Such an operation takes several hours, usually no more than 6.

The next stage of surgical intervention is carrying out cardiotonic (supporting cardiac activity) and immunosuppressive treatment. Suppression of immunity (usually by using cyclosporine) is required to eliminate rejection reactions and successful engraftment of the graft.

Possible complications after transplant

Among the complications that can occur in the early period after surgery are bleeding from a wound, infectious lesions. The first is quite successfully treated by re-opening the wound and suturing the source of bleeding. To prevent infectious (viral, fungal, bacterial) complications, the patient is prescribed antibiotic drugs and an adequate immunosuppression regimen.

In the long-term period after the operation, the development of rejection of the transplanted heart, as well as dysfunction of the coronary arteries, accompanied by myocardial ischemia of the donor organ, is likely.

Forecast

The cost of a heart transplant in Russia does not always affect the prognosis. It is most often favorable: more than 90% of recipients successfully survive the first year after surgery, about 60% - five years, about 45% - more than 10 years.

Post-transplant lifestyle

The patient's lifestyle in the postoperative period after the heart transplantation procedure consists of the following components:

1. Nutrition. It is important for the patient to switch to a healthy lifestyle, completely abandon the use of alcoholic beverages, tobacco smoking. You must follow a diet, excluding harmful foods (smoked, fried, fatty, and so on) from your own diet.
2. Physical activity. During the first month after surgery, the patient must strictly adhere to the restrictive regimen. However, the usual daily activities should still be present. After a couple of months, the patient is allowed to return to driving, after a few more months - to start light physical activity (walking, gymnastics, etc.).
3. Protection against infections. The patient should try to avoid visiting public places for several months after the transplant, contact with people with infectious diseases. It is equally important to wash your hands thoroughly before eating, drink exclusively boiled water, and eat food that has undergone good heat treatment. This is due to the fact that due to suppressed immunity, the likelihood of a patient becoming infected with viral, fungal, bacterial diseases increases after the start of immunosuppressive treatment.
4. The use of drugs. This is the most important part of a heart transplant patient's life. The patient will have to carefully observe the time of taking medications, exactly follow the dosage prescribed by the doctor. As a rule, we are talking about the use of hormonal drugs and cytostatics, the action of which is aimed at suppressing their own immunity, attacking foreign tissues of the heart muscle.

In general, it should be noted that the patient's life after surgery undoubtedly changes significantly, but the quality of life without edema, palpitations and shortness of breath changes for the better.

Heart transplant from a religious perspective

Earlier, when the field of transplantation was just beginning its development, representatives of almost all religions had mixed opinions about heart transplantation. For example, representatives of Christianity believed that such an operation was not a godly deed, since a person's heart was actually taken away from him. In addition, it is believed that theoretically a person can come out of a coma after a few months. But due to the fact that doctors clearly differentiate the state of coma and brain death, more and more clergy in recent years began to say that saving someone else's life after their own death is the true destiny of a believer, since sacrifice is the basis of such an action. And donating your heart is good for other people.

We have reviewed the cost of heart transplant in Russia.

A heart transplant, or heart transplant, is a surgical procedure that involves replacing the heart of the patient (recipient) with the heart of a donor. For patients with end-stage heart failure, coronary artery disease, arrhythmias, cardiomyopathy and other serious diseases, a heart transplant is the only chance at life. Currently, there is an acute shortage of heart donors, which forces patients to be on the waiting list for transplantation for many years.

Indications for surgery

Heart transplantation is mandatory for patients with severe heart failure, which poses a direct threat to life and does not respond to treatment, patients with coronary artery disease, valve disease, cardiomyopathy and congenital heart disease. More than 70% of patients waiting in line for transplantation suffer from end-stage heart failure, which practically does not respond to therapy. 25% of them die before their turn.

Such a complex procedure as organ transplantation requires a certain preparatory period, which implies:

• being in a hospital under the supervision of a cardiologist;
• donating blood for general analysis;
• conducting a cardiac catheterization procedure;
• taking an echocardiograph test;
• passing a survey and a written test on the presence of diseases of other organs and systems of the body, which may be a contraindication to surgery;
• carrying out immunosuppressive therapy.

Donors

The problem of lack of donor organs arises for a number of reasons affecting the technical and physiological aspects of the transplant procedure:

1. 1. It is impossible to transplant a heart from a living person. In no country in the world is organ transplantation from a living person allowed, as it is considered murder, even if the potential donor himself wants it. The heart is taken from a deceased person whose brain death has been officially recorded. A person must give permission during life to remove their organs after death.
2. 2. The lifespan of an organ separated from the body is about 6 hours. At the same time, conditions of storage and transportation must be provided, otherwise the heart will become unsuitable for surgery. The organ is transported in a special insulating container immersed in a cardioplegic solution. The optimal duration of the heart's stay in such a container is 2-3 hours, after which structural changes are possible in the donor heart.
3. 3. The future donor should not have bad habits, diseases of the cardiovascular system, and his age should not exceed 65 years.
4. 4. The main difficulty of transplantation was and remains histocompatibility, or organ compatibility. You cannot transplant a heart from a random person, even during immunosuppressive therapy, as this will cause organ rejection. Compatibility is determined by analyzing the blood of the donor and recipient and identifying as many of the same specific protein antigens as possible.

Bypass grafting of cerebral vessels - how is the operation performed and what are the consequences?

Heart transplant procedure

The procedure is carried out after the preparatory period has passed, and if no contraindications to transplantation have been identified. The operation is performed by several teams of surgeons, cardiologists, anesthesiologists and a dozen assistants, and the procedure itself takes from 8 to 12 hours. The patient is given general anesthesia, which immerses him in a deep sleep, after which the surgeon opens the patient's chest and fixes its edges so that they do not interfere with the procedure. After that, the vessels are alternately disconnected from the heart muscle and reconnected to the heart-lung machine. During the operation, the device performs the functions of the patient's heart and lungs. After all the vessels are disconnected, the heart itself is removed, and the donor heart is placed in its place. After that, the procedure is repeated in the reverse order and the doctor attaches all the vessels to the new donor organ.

Most often, the new heart begins to beat on its own after the transplant, and if this does not happen, the doctor uses electric shock to stimulate the heart rate. Only after the heart beats on its own is the heart-lung machine disconnected from it.

Heart transplant surgery

After the operation, the patient continues to be in the hospital to monitor the transplanted organ. A cardiac monitor is connected to the patient, which shows the heart rate and a breathing tube if the patient cannot breathe on his own. A pacemaker is connected to the heart muscle, which will adjust its work and drainage tubes to drain the accumulated fluid and blood in the postoperative period.

Consequences of the operation

The early postoperative period is the most difficult in terms of adaptation of the new organ to the changed conditions of functioning. With a positive outcome of the operation and the absence of serious complications, the normal performance of the heart returns in about 3-5 days. It is during this period that complications such as:

• rejection of the donor heart;
• thrombosis of the heart arteries;
• impaired brain function;
• disruption of the lungs, liver, kidneys and other organs.

In the next 7-10 days, complications such as:

• infectious infection;
• coronary artery disease;
• internal bleeding;
• pneumonia;
• arrhythmia;
• the development of oncological neoplasms against the background of immunosuppressive drugs in the preoperative period.

All these consequences can manifest themselves in a different order and at different time intervals after the operation. Post-transplant complications occur in more than 90% of cases, most often arrhythmias, coronary artery disease, and internal bleeding. Any complications to one degree or another can cause the death of the patient.

Forecast

The life prognosis of transplant patients is positive. If there were no complications in the postoperative period, then the survival rate in the five-year period is more than 80%, and the mortality after this period is less than 5%. The most common cause of death in the first five years is rejection, infection and pneumonia of the heart. About 50% of patients live longer than 10 years after transplantation.

A donor organ in a new organism is able to work for 5-6 years without any serious disturbances, but the processes of tissue degradation and muscular dystrophy proceed in it much faster than would occur in the organ's native organ. For this reason, over time, the patient begins to feel weakness in the body, dizziness, and his general condition gradually worsens.

It is technically possible to carry out the operation, but the probability that the patient will not die during the operation is hardly more than 50%. If we take into account that the average age of patients per turn is 55-60 years old, then the second operation will be performed at the age of about 70 years. It is obvious that the body will not only not survive the operation itself, but will not even cope with immunosuppressive therapy. Therefore, to date, there are no recorded cases of repeated heart transplantation.

Heart transplant (transplantation) is a complex surgical procedure, which consists in voluntarily replacing a patient's diseased organ with a healthy one (donor).

The success of the operation will depend on a number of factors:

1. The time it takes to find a suitable donor. Patients who are indicated for transplantation already have a serious pathology that threatens their lives. Long waiting times can be fatal. In this case, the earlier the operation is performed, the greater the likelihood of its positive outcome.
2. The time it will take to transport the donor heart. Transportation and implantation should be carried out within 3-6 hours after removal from the body. After this period, the organ loses its vitality, since irreversible structural changes occur in it. The heart is transported in a medical insulating box filled with cardioplegic solution.
3. Qualifications and experience of the operating cardiac surgeon.

Indications and contraindications

The indications for transplantation are severe pathologies of the cardiovascular system that are not amenable to conservative treatment methods:

• chronic heart failure of the last stage;
• ischemic heart disease at the stage of dystrophic changes;
• stretching of the heart, accompanied by systolic dysfunction (dilated cardiomyopathy);
• severe arrhythmic disorders;
• anomalies of the heart of congenital genesis, not amenable to plastic correction;
• valve pathology (mitral, tricuspid, etc.);
• progressive angina pectoris, signs of severe stenosis of the coronary arteries;
• symptoms of benign tumor neoplasms (, fibroma, etc.).

There are a number of contraindications for which transplantation is inappropriate:

• nicotine, alcohol and drug addiction;
• oncological diseases;
• diabetes;
• chronic pathologies in the acute stage;
• severe obesity;
• diseases that are accompanied by inflammatory processes;
• pulmonary hypertension;
• viral and infectious diseases (HIV, viral hepatitis, tuberculosis, sepsis);
• autoimmune disorders (arthritis, vasculitis, hemolytic anemia, etc.);
• collagenosis (lupus erythematosus, scleroderma, rheumatism);
• serious disorders of the kidneys, liver, lungs;
• mental disorders, exacerbation of violations of social behavior.

Most often, transplants are performed for people under the age of 65, but there are exceptions.

The possibility of a heart transplant is considered by the attending physician and the patient individually. The patient's desire, his readiness for the necessary diagnostic and rehabilitation procedures are taken into account.

In the absence of consent from the patient, the doctor explains to him the possible consequences of this decision. If after that he voluntarily refuses surgery, the transplant is not performed.

How much does it cost?

This operation is one of the most expensive in the world. On the territory of the Russian Federation, the cost of transplantation starts at $ 100,000.

Heart transplant operations in Russia are performed only by three scientific research medical organizations:

• Federal Research Center for Transplantology and Artificial Organs named after V.I.Shumakov (Moscow);
• Research Institute of Circulatory Pathology named after E. N. Meshalkin (Novosibirsk);
• FSBI "North-West Federal Medical Research Center named after V. A. Almazov" (St. Petersburg).

In addition, on the territory of the Russian Federation, within the framework of the compulsory medical insurance policy, it is possible to provide high-tech medical care under quotas, that is, free of charge. But this is all decided on an individual basis, depending on each specific case.

In European countries, the price is much higher, where the operation costs - from 250 thousand dollars. According to data for 2018, the minimum cost is set in India - from 70 thousand dollars.

The heart itself cannot be bought, only the operation is paid for. This is due to the fact that organ trafficking is prohibited throughout the world.

Where do donors come from?

As a rule, people most often become donors after a serious accident. They are in intensive care, while their brain must be dead, that is, there is no chance for such people to survive, and the work of their body is supported artificially, with the help of medicines and a ventilator.

In this case, relatives may decide to donate the organs of this person. To do this, they need to sign the relevant documents.

And also a person himself can make a will in his lifetime, which will indicate that after death he donates his organs to the needs of medicine.

How long to wait for a donor heart?

Searching for a donor is a long and complicated process, with rare exceptions. The average waiting time is up to 2 years. During this period, the patient's health is maintained with medication.

Lack of donors is an acute problem in modern transplant centers. Because of this, many people die without waiting for a transplant, since it is necessary to queue long before this operation is even needed. Serious heart disease progresses rapidly and requires urgent treatment.

A patient waiting for a transplant is registered on a so-called waiting list. If the donor is found quickly enough, the operation will be performed as planned, having previously performed the necessary diagnostic procedures. If the patient's condition worsens before the donor is found, he is hospitalized in the cardiac surgery department.

This is what a photo of a donor heart looks like

Patients who require urgent transplantation to save their lives move up the list.

The main difficulty in finding a donor is due to the fact that the transplanted heart must meet certain criteria:

• donor age up to 45 years;
• lack of structural and functional organ pathologies;
• absence of violations of the contractile activity of the myocardium;
• correspondence of the blood group and Rh-belonging of the donor and the patient;
• immunological compatibility;
• anatomical correspondence of the size of the donor organ to the size of the patient's heart (deviation of 20-30% is allowed). Therefore, the male heart is often transplanted to men, and the female to women.
• the donor has no chronic diseases and bad habits that have a negative impact on the heart condition.

Preparing for surgery

Before performing an operation, doctors must make sure that the patient is physically ready for this and that the state of his body will allow him to undergo it.

To do this, he will have to undergo the following examinations:

• General analysis of blood and urine, coagulogram, determine the blood group and Rh factor.
• Analysis for HIV, viral infections, hepatitis, syphilis.
• EchoCG, ECG.
• Check for oncology.
• Chest x-ray.

How does the transplant take place?

The average duration of a human heart transplant operation is 6 to 12 hours.

There are two technologies by which the transplant is performed - heterotopic and orthotopic. Their fundamental difference is where and how the donor organ will be located.

In the heterotopic variant, the patient's heart remains in place, and the graft is placed next to the "native" heart, creating additional vascular connections for its functioning. This option has both advantages and disadvantages. The advantage is that in case of rejection, the donor organ can be removed. Among the disadvantages should be noted the high risk of blood clots and squeezing of organs located nearby.

In orthotopic transplantation, the patient's ventricles are completely removed, and the atria of the donor heart are connected to the atria of the recipient's heart. The atria continue contractile activity, maintaining the physiological rhythm, while the patient is connected to a heart-lung machine. To control and maintain the rhythm of heart contractions, a pacemaker is installed.

As for the very technique of performing a heart transplant operation, there are quite a large number of them, but the most common are two - biatral and bicaval.

With biatral, the donor's heart connects with the recipient's body through the atria, aorta and pulmonary artery, and with bicaval, this happens through the vena cava. The second option is considered more progressive and causing the least complications after surgery.

At the end of the operation, after the cardiac surgeon connects large vessels with the recipient's circulatory system, the transplanted heart can begin contractile activity on its own. If this does not happen, then the heart is started "manually". Several electric shocks are given to stimulate the heart.

Then doctors check the tightness of the vessels, look for bleeding. In the event that everything is in order, then the patient is disconnected from the artificial life support apparatus.

Can the heart of an adult be transplanted to a child?

An adult cannot become a donor for a child for the reason that the transplanted organs must match each other in size. Unlike liver and kidney transplants, where adults are donors for children, hearts can only be transplanted from a child to a child of approximately the same age.

In world medical practice, there are examples of successful heart transplantation for babies under 5 years old. On the territory of our country, such operations are carried out after the child reaches the age of 10.

Heart transplantation is much more difficult for a child than for an adult. In addition to the difficulties associated with finding a donor, it should be borne in mind that a child's fragile organism is more difficult to tolerate long-term intake of necessary medications. In children, late rejection of the biomaterial occurs more often and complications that lead to death progress faster.

Possible complications

After the surgery, the recipient is left with a scar from the incision in the chest, which starts in the sternoclavicular joint and goes down to the navel. In order not to attract undue attention of others and to live as before, patients are forced to hide it under clothes with a high collar, or use special masking cosmetics.

The most dangerous and difficult period, requiring maximum adaptation of the body to a new organ, is the first ten days after transplantation.

At the initial stage of engraftment, the following complications may occur:

• graft rejection;
• thrombosis of large arteries and vessels;
• development of the infectious process;
• internal bleeding;
• stagnant processes in the lungs, pneumonia;
• pathology of the kidneys and liver;
• effusion pericarditis (inflammation of the pericardium, which is accompanied by an increase in effusion in its cavity);
• arrhythmias.

In addition, there are late complications that can appear both during the first year and after several years:

• the development of oncological diseases (melanoma, lymphoma, myeloma, etc.);
• myocardial infarction;
• ischemia;
• valve insufficiency;
• atherosclerosis;
• vascular diseases - vasculopathy.

Rehabilitation and further lifestyle

Rehabilitation lasts about one year. The patient spends the first few days in the intensive care unit under the close supervision of medical personnel and constant monitoring of the donor heart.

Early stage

Immediately after the operation, the patient must perform breathing exercises in order to restore the ventilation capacity of the lungs. While the patient is in the supine position, it is recommended to perform passive movements (flexion-extension of the legs in the supine position, movements of the ankle joints) in order to prevent the risk of blood clots.

The patient spends the next 3-4 weeks in the hospital in the cardiology department. The main goal of drug therapy at this stage is to suppress the immune response from the body in order to prevent possible rejection of a foreign organ. For this, the patient is prescribed immunosuppressants in high dosages, and the patient also takes vasoprotectors, cytostatics and cardiac stimulating drugs.

At this stage, the patient's condition is monitored using diagnostic procedures - ECG, tests to identify possible infections, X-rays of the lungs, blood pressure monitoring. A person may periodically experience nosebleeds, most often it is caused by taking anticoagulants, for example, heparin, which prevents thrombosis and improves hemodynamics.

Late stage

For the first months after surgery, patients should have a myocardial biopsy every two weeks. Based on its results, the doctor assesses how the donor organ takes root, determines the dosage of medicines. Thanks to this procedure, the process of the onset of rejection is diagnosed at an early stage.

During the home rehabilitation phase, immunosuppressive therapy is still underway, as graft rejection can occur within a year. The patient continues to regularly visit the hospital for control procedures, routine examinations.

In the recovery period, it is especially important to take care of yourself and minimize the likelihood of infectious diseases by refusing to visit places where a large number of people gather. Any minor illness due to a depressed state of the immune system can cause serious complications.

There are certain restrictions on physical activity and nutrition. Despite some prohibitions, for a quick recovery, it is recommended to perform a daily complex of therapeutic exercises, agreed with a doctor. Patients should adhere to a diet, exclude fatty salty, fried foods, steam, eat vegetables and fruits, and forget about alcohol. It is allowed to use only products that have undergone complete heat treatment, it is recommended to drink boiled water. It is forbidden to visit the baths, saunas, hot baths.

How many years do you live after surgery?

The prognosis of life after transplantation is favorable, it is effective. Patients can serve themselves, maintain moderate physical activity and even work capacity in the most lightweight working conditions. Reviews of people who have undergone surgery simply cannot be negative, simply because it is prescribed only in critical situations and without it - they would already be dead.

According to statistics, after a successfully completed transplant, the life expectancy of patients increases by 5-10 years.

One year after transplantation, 85% of patients survive, then this number decreases due to complications arising in the form of infectious processes and oncological diseases. Mortality several years after transplantation is due to developing pathologies of blood vessels and valves. So, after 5 years, the survival rate is no more than 70%, 45% live for more than 10 years, and only 15% live for 20 years or more.

Organ transplants from voluntary donors are quite widespread in modern medicine. The same applies to cardiology. True, heart transplantation is a very difficult and not very common manipulation. The development of this area is being carried out by cardiologists together with immunologists. It is immunologists who are studying the principles of rejection of a foreign organ.

Experiments on transplantation began in the 50s, and the first heart transplant was performed in 1980, by scientists from the United States and South Africa. In our country, such an operation was carried out by V.I. Shumakov, in 1988. Despite the complexity of the procedure itself, its cost, quite high and possible rejection, the need for such transplants is increasing every year, and medicine is doing everything possible to reduce the risks awaiting the patient.

Who is the transplant indicated for?

Getting a donor heart is a rather difficult task, so transplantation of this organ is performed only as a last resort. There are a number of heart conditions for which transplantation is possible. The indications for such manipulation will be the following pathologies in the last most severe form:

1. The last stage, in which the patient is severely limited in motor activity, pathological edema of the extremities or even the whole body appears, at this stage shortness of breath is present even at rest.
2. Severe heart defects, both congenital and acquired.
3. Diseases that cannot be cured by either conservative or surgical methods - severe heart rhythm disturbances, uncontrollable angina pectoris.
4. Cardiomyopathy, in which structural changes occur when the myocardial fibers are replaced by scar tissue.
5. Swelling in the heart.

All such cases of cardiac abnormalities need to be reinforced by the patient's desire for such a surgical intervention, his attitude to lead an absolutely healthy lifestyle and until the end of his life is under the strict control of doctors.

What can interfere with the operation

Unfortunately, not every patient will be able to receive a donor heart. There are many different reasons for this:

1. Very few donors. It can only become a person whose brain death is registered, and the heart is absolutely healthy.
2. There is a very long queue (waiting list) to receive this organ, it is most important for children. The organ must fully comply with all the stated requirements, and it is possible that several dozen more patients who are much earlier on the list will have such parameters.
3. Sometimes the donor organ cannot be delivered to the right place on time, since the operation must be performed no later than six hours after the removal.
4. Many people disagree with the transplant on ethical or religious grounds. For example, in Christianity, a person is alive as long as his heart beats.
5. The patient can be stopped by the fear of long and rather expensive rehabilitation.
6. Advanced age. Usually, operations are not performed on people over 60, but there are exceptions.

In addition to the listed obstacles, the transplant will not be carried out for a number of other diseases that are not related to cardiology. It can be:

• in severe form;
• diabetes mellitus in a stage at which negative changes in the retina of the eyes, in the vessels or kidneys have already begun;
• infectious diseases in the acute stage;
• HIV and tuberculosis;
• autoimmune diseases - rheumatism, arthritis, lupus erythematosus, etc .;
• severe hepatic or renal failure;
• chronic severe lung disease;
• oncology;
• addiction to alcohol or drugs;
• severe mental disorders.

Donor heart requirements

As mentioned earlier, the heart can be removed only if the complete death of the brain is confirmed and if the donor organ has no pathologies. This can only happen in a clinic setting. The donor is usually in a coma, on artificial respiration. This happens most often after an accident or stroke. A panel of leading doctors confirms brain death. Further, relatives are asked for written permission to remove donor organs; their consent can be dispensed with only if there is still a lifetime consent to become a donor.

If the patient is not identified or has no family, the doctor can make a decision on his own. A commission is assembled at the head, which will be the chief physician of the medical institution and fills in all the documents necessary in this case. After the arrival of the surgeon and the assistant nurse, an organ harvesting operation is performed. The heart is placed in a special container with a solution and taken to the transplant center.

When selecting a donor heart, healthcare professionals adhere to the following criteria:

1. There are no chronic heart diseases, which is necessarily confirmed by the ECG. When the donor has reached the age of 45, it is necessary to undergo coronary angiography.
2. Absence of hepatitis B and C or HIV.
3. There should be no tumors.
4. Obesity.

It is obligatory to check the compatibility of the heart of the donor and recipient. To do this, check:

• for blood group compatibility;
• approximate match in size of hearts, this is especially true for children. Such an analysis is carried out using ultrasound.

How quickly can you make a transplant

In the event that a doctor strongly recommends a heart transplant, a person needs to register with a medical transplant center. Here the patient is put on the waiting list for the donor organ. In our country, there is only a "Single Coordination Center", which carries out the selection of suitable donors. This center is in constant contact with a number of hospitals with trauma or neurological departments. It is from here that donor hearts most often come.

The transplant itself is performed by:

1. In the Moscow FGBU FSCTI named after Shumakov V.I.
2. At the FSBI Northwestern Federal Medical Research Center named after Almazova V.A. It is located in St. Petersburg.
3. At the Scientific Research Institute of Circulatory Pathology, which is located in Novosibirsk.

Unfortunately, in our country there are a number of strict legislative restrictions on the collection of donor organs and hearts suitable for transplantation are extremely rare, which means that the waiting list is very long. The most difficult situation is with heart transplantation for young children. In our country, this kind of operation is prohibited by law and the only way out is to seek help from foreign clinics.

How much does heart transplant cost

All citizens of the Russian Federation have the right to free high-tech medical care, which includes transplant operations. On this basis, if there is a suitable heart, it will cost the patient nothing. But, in addition to heart transplant surgery, the patient will have a long and expensive rehabilitation. This period can be prolonged and require from the recipient from 50 thousand dollars. For children, such a transplant will be much more expensive, since both the selection of the donor and the operation itself will have to be performed in a foreign clinic.

Transplant preparations

After a person makes an application at the transplant center, he will need to undergo a detailed examination. The diagnostic plan will include the following manipulations:

• a blood test for the presence of viral hepatitis of any type, HIV, syphilis and others;
• clotting test and confirmation of blood type;
• general urine analysis;
• fluorography;
• ECG, CAG and ultrasound of the heart;
• additional examination by the center's cardiac surgeon;
• examinations of an otorhinolaryngologist, dentist, gynecologist and urologist.

The patient must always have with him - a passport, SNILS, medical policy, as well as a referral for transplantation from a medical institution where the patient was observed and an extract with the results of the examination.

It is necessary to have these documents with you due to the fact that the donor may appear completely unexpectedly, and the recipient needs to be on the operating table as soon as possible.

Transplant process

Surgery in this case usually lasts for about six hours under general anesthesia.

The heart transplant operation itself is usually performed according to the following algorithm:

1. Immediately before the start of the surgery, blood is taken from the patient again for a general analysis, blood pressure and sugar level are measured.
2. The recipient is injected with anesthesia, designed for an operational process of 6-10 hours.
3. After processing the outer surface of the patient, the chest is opened and transferred through the vena cava to the artificial circulation system or "artificial heart".
4. The doctor removes the ventricles of the recipient's heart, leaving the atrium and great vessels. Then, instead of the removed ventricles, the donor heart ventricles are sutured.
5. The patient is temporarily installed with a pacemaker, which is designed to regulate the rhythm after surgery.
6. The patient's chest is sutured. Unfortunately, the scar after such an operation is quite large, going from the neck to the navel. The operated person remains with a large and thick scar for life.
7. The recipient receives therapy aimed at maintaining cardiac activity and suppressing immunity, which prevents the possibility of rejection of the donor organ.

Pediatric transplantology

A heart transplant for a child is the most difficult operation in this area, and it is performed much less frequently than for adults. A direct indication for such an operation will be if the heart disease enters the terminal stage and the baby remains alive for about six months. Children's donor hearts are rare and almost half of children do not live to see surgery.

The process of heart transplantation for a child is also somewhat more complicated than for an adult patient, and the survival rate is also much lower. Quite often, doctors are faced with late organ rejection, coronary atherosclerosis and nephrotoxicity.

Postoperative period

This period can be roughly divided into 4 periods.

1. The resuscitation period lasts approximately ten days. Here, the patient receives intensive therapy aimed at preventing the rejection of a foreign organ, at stopping any other complications such as bleeding, allergic reactions, fluid accumulations in the pericardium, etc. At this time, the patient is very susceptible to any viral, fungal or bacterial infections. The task of the medical staff is to prevent such a development of events.
2. Hospital stay - the patient will have to spend at least 30 days in a medical facility. During this period, an individual regimen for taking medications will be developed and a number of necessary studies will be carried out.
3. Post-hospital period - the patient is at home, takes prescribed medications, is monitored by doctors and gradually moves to his usual way of life. This recovery time can take about a year.
4. The fourth period will last for the rest of your life and is characterized by the restoration of partial working capacity and the ability to lead a fairly active lifestyle. A person who has undergone an operation is obliged to undergo regular examinations, which will allow them to monitor the process of the new organ and constantly support it. In addition, it is absolutely necessary to lead an absolutely healthy lifestyle and follow the diet recommended by doctors.

Life expectancy after surgery

Considering the fact that this operation is very complicated both in terms of execution and consequences, the risk is quite serious. According to statistics, in the first year, about 85% remain alive, then the percentage decreases slightly - to 73%. Usually, a new heart works well until the age of seven, but it is significantly more prone to degeneration than a healthy one. About half of the operated patients survive until ten years old, although there are cases when the patient lives for a long time and conducts moderately active physical activity. After a heart transplant, people can even drive safely.

All patients receive clear guidelines for their future life after transplantation, and it is best to follow.

• Regular intake of prescribed medications in compliance with the dosage.
• Monitor the moderation of physical activity.
• Follow a diet and exclude drinking and smoking.
• Refuse to take hot baths.
• Try to avoid large crowds of people to limit contact with infections.

Despite the fact that the recipient will have to comply with a number of restrictions throughout his life, his quality of life is still greatly improved. It must be understood that the patient came to the operation with a profound disability, which was accompanied by severe shortness of breath, palpitations and swelling. All these and many other symptoms hardly allowed a person to live and do everything he would like.