The cardiac surgery

THE CARDIAC TRANSPLANTATION

- The indications of the transplantation
- The transplantation technique

The indications of the transplantation

The main indication is represented by the irreversible cardiac insufficiency, very bothersome from a functional point of view (occurrence of a very important shortening of breath, of an extreme fatigue) and resisting any medical treatment.

The left ventricle is very tired and the ejection fraction (i.e. the proportion of blood coming out of the heart) is often below 25%. The heart output is also decreased and the pressure at the level of the lungs increases.

The assessment method of the most sensitive cardiac insufficiency is the measure of the gaseous exchanges expired during an effort, in particular the measure of the oxygen volume (VO2 max). A VO2 max below 14 ml/min/kg should lead to a cardiac transplantation.

The mechanisms of the cardiac insufficiency are the following ones: either the heart is dilated (case of the primitive dilated cardiopathies secondary to a myocardial infarction), either the heart is hypertrophied and cannot fill up any more (obstructive cardiomyopathies), either again the heart muscle presents an illness of its own (case of the myocarditises, corresponding to an inflammation of the cardiac muscle due to an infective agent).

In some cases, some congenital cardiopathies require a cardiac transplantation.

The main contra-indications appear on the table below. The most important contra-indication is represented by the existence of a pulmonary hypertension resulting in an increase of the pulmonary resistances. In case of an attack of the lung, a heart-lung graft is then necessary.

Contra-indications of the cardiac transplantation

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File last reviewed on dec 18, 2011