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Heart and Heart–Lung Transplantation

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Cardiac Surgery

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Abstract

Cardiac transplantation is the only treatment option for significant, irreversible functional impairment of the heart despite maximal medical therapy. The most common causes in adults are either idiopathic dilated cardiomyopathy or ischaemic cardiomyopathy caused by coronary artery disease. In children, indications are frequently complex congenital heart malformations, in many cases after multiple surgical palliations, or hereditary dilated cardiomyopathies.

Cardiac transplant candidates need careful evaluation of co-morbidities and optimal medical management during waiting time. After allocation of a donor heart, donor and recipient operation for orthotopic heart transplantation is based on the technique developed by Lower and Shumway. The implantation might be complicated by previous cardiac operations or by the use of a mechanical circulatory support device.

Indications for combined heart and lung transplantations are declining, nowadays limited to patients with terminal double organ failure, mostly due to congenital heart disease with subsequent severe treatment-resistant pulmonary hypertension. The surgical technique was developed by Bruce Reitz and coworkers at Stanford University.

The most common complication in the first year after transplantation is acute cellular rejection. For prevention, roughly 50 % of transplant centres use initial antibody induction therapy. Most maintenance immunosuppressive protocols employ a three-drug regimen consisting of a calcineurin inhibitor, an antimetabolite agent, and tapering doses of glucocorticoids.

Besides the underlying disease and the development of transplant-specific graft vessel disease, a major problem in long-term heart transplant recipients remains that is the complications caused by chronic treatment with immunosuppressive compounds.

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Authors and Affiliations

  1. Transplant Center Munich, University of Munich Medical Center, Munich, Bavaria, Germany

    Bruno Meiser MD

  2. Consortium Xenotransplantation, German Research Foundation Transplant Center, University of Munich, Munich, Bavaria, Germany

    Bruno Reichart MD

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  1. Bruno Meiser MD
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  2. Bruno Reichart MD
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Correspondence to Bruno Meiser MD .

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Editors and Affiliations

  1. Department of Surgery, The University of Chicago, Chicago, IL, USA

    Gerhard Ziemer

  2. HTTG - Surgery, Medizinische Hochschule Hannover, Hannover, Germany

    Axel Haverich

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Meiser, B., Reichart, B. (2017). Heart and Heart–Lung Transplantation. In: Ziemer, G., Haverich, A. (eds) Cardiac Surgery. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-52672-9_37

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  • DOI: https://doi.org/10.1007/978-3-662-52672-9_37

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