Heart transplant program and artificial heart support systems

The Heart Transplant Program and Artificial Heart Care Systems are a team-based organization in which specialists from many different fields work together before and after a heart transplant. In addition to the heart transplant surgeon and the heart failure cardiologist, the team includes organ transplant coordinators, as well as specialists in the following areas: lung disease, infectious diseases, nephrology, psychology / psychiatry, pathology and dentistry, at in addition to nurses with experience in organ transplantation, social services specialists, physiotherapists and dietitians.

 

What is heart failure?

 

The heart is a vital organ that allows blood to circulate in the body.Poor – Oxygen blood returning to the heart is pumped into the lungs through the right ventricle. The blood is oxygenated in the lungs and sent to the left atrium of the heart, and then pumped throughout the body.

 

Heart failure occurs when the left, right or even both ventricles no longer function normally. Heart failure is a progressive disease, so the strength of the heart gradually decreases over time. The heart becomes unable to pump the amount of blood needed by the body. Tissues and cells have difficulty providing oxygen and nutrients.

 

Heart failure can occur at any age, depending on the underlying cause. However, in 2.5% of cases, it occurs in people over the age of 45, and in 10% of cases in people over 65 years. It is the leading cause of hospitalizations and mortality, both worldwide and in Turkey. In the final stage of heart failure, more than half of patients die within the first year after diagnosis.

Diseases that cause heart failure

 

  • Coronary heart disease: The most common heart disease. The coronary arteries that feed the heart are narrowed and / or clogged, which means that the myocardium can no longer be able to get the necessary oxygen and nutrients, deteriorate or even die (heart attack), causing a decrease in contraction.
  • Complex valvulopathy: These conditions of the aorta and mitral valve, congenital or acquired, increase the workload of the heart, thus causing heart failure due to dilation or stress of the heart.
  • Dilated cardiomyopathy: The heart is dilated and enlarged, causing heart failure associated with abnormal myocardial contractions caused by impaired heart muscle function.
  • Myocarditis: A disease that is caused by a decrease in the strength of the heart to contract due to a viral infection. Dysfunction of the heart contraction may disappear completely after the viral infection has healed or may become permanent, leading to heart failure.

 

Treatment of heart failure

 

In order to treat heart failure, it is possible to resort to drugs, diet, arrhythmia rectification mechanisms, as well as surgery to correct the diseases that cause heart failure (coronary bypass, valve replacement operations, etc.). However, the most effective treatment for end-stage heart failure remains heart transplantation and artificial heart support mechanisms.

What is a heart transplant?

 

The purpose of a heart transplant is to replace a dysfunctional diseased heart with a healthy heart. When a healthy person who has previously made the decision to donate their organs (donor) dies, kidneys, liver, heart, etc. they are prepared to be transplanted to patients (beneficiaries of the transplant) for whom the decision to transplant a particular organ has already been made.

 

Who can benefit from a heart transplant?

 

Heart patients under the age of 65 are candidates for a heart transplant. They must be in the terminal stage (stage-D) of heart failure, with a life expectancy of less than 1 year. Older patients (between 65 and 72 years old) will be thoroughly evaluated, with an emphasis on their physical characteristics rather than their age, and if they are considered eligible, they will be included in the program.There are two common causes of a heart transplant. The first cause is coronary heart disease. These patients cannot be cured by coronary bypass surgery or coronary angioplasty. Irreversible or severe myocardial damage may occur as a result of previous attack (s) associated with clogged coronary arteries. The other cause is congenital or acquired heart weakness, caused by bacteria, viruses, etc., called cardiomyopathy. It may require a heart transplant when the contraction power of the myocardium is significantly reduced. Other rarer causes include: rheumatic fever, hypertension, valvular diseases caused by myocardial damage, congenital heart abnormalities that cannot be surgically corrected, and heart tumors. Patients with severe arrhythmias associated with various diseases, which cannot be stopped despite the administration of medication and the placement of a pacemaker, are also candidates for a heart transplant. In order to be included in and voluntarily participate in a heart transplant program, patients and their family members must be aware and confident that:

  • All known methods of treating their heart disease have been considered, applied and tested,
  • They will lose their life if they do not have a heart transplant,
  • They will be able to adapt to the changes in their lives, as well as to certain demands that will be needed for a lifetime or for a certain period of time before and especially after the transplant procedure. In order to be included in the program, patients will be evaluated by the specialists of the heart transplant team regarding the medical, psychological and social characteristics mentioned above.

 

What is an artificial heart support mechanism?

 

An artificial heart support mechanism is a mechanism based on state-of-the-art technology that takes over the function of pumping the heart in patients with end-stage heart failure. Temporary artificial heart support systems are used until heart failure is cured or a heart transplant is performed, while permanent artificial heart support systems are used throughout life.

Who can benefit from an artificial heart support mechanism?

 

Artificial heart support mechanisms are used in patients with end-stage heart failure, developed suddenly or over time, with four main purposes.

  • For maintenance (short-term use), in order to avoid dysfunction of other organs in patients who have suddenly developed heart failure, as well as to keep patients alive until the activation of a permanent artificial heart care system.
  • For maintenance until healing, in order to keep the patient alive when the disease progresses significantly, for example in the case of diseases that lead to the sudden development of heart failure that causes myocarditis (inflammation of the myocardium due to viruses, etc.), but which will be completely cured after pharmacotherapy.
  • For maintenance until the time of the heart transplant in the case of patients who are on the waiting list but who have progressive heart failure while waiting for the heart to undergo the transplant.
  • For lifelong use, in order to improve the time and quality of life of patients who cannot benefit from a heart transplant for various reasons (old age, severe kidney or liver disease, etc.).

 

Who performs the heart transplant surgery and the artificial heart support mechanism?

 

Heart transplant operations and the artificial heart care mechanism are performed in fully equipped hospitals, authorized by the Ministry of Health, which benefit from an experienced team in organ transplantation and artificial heart systems, with heart transplant programs.

 

How can I be included in a heart transplant program and artificial heart support mechanism?

The cardiologist, who has information on the patient’s medical history and monitors him, consults the board for a heart transplant and artificial heart care systems when he considers that a heart transplant is needed to cure the disease. During the pre-assessment, the patient’s medical history, condition, tests, physical condition, and other details are taken into account. The patient’s condition is assessed in detail by the committee, which usually consists of: a heart transplant surgeon, a cardiologist, an anesthetist, a lung specialist, an infectious disease specialist, a transplant coordinator, and a secretary. Other necessary tests and consultations are planned (psychiatry, endocrinology, nephrology, dentistry, etc.). If, on the basis of the evaluation, the board for heart transplantation and artificial heart care systems considers that the patient can be accepted for a heart transplant, the patient will be included in the program and registered in the waiting list for organs.

 

What happens during the waiting period for a heart transplant?

 

Patients who are on the waiting list by the Board for Heart Transplant and Artificial Heart Care Systems and whose health is good enough to stay at home will wait for the right heart at home and have regular checkups, while patients with severe heart failure will be hospitalized while waiting for the right heart. The patient’s place on the waiting list depends on his state of health, his blood type, the size of the body of the transplant recipient compared to that of the donor, the waiting period for the organ. As is normal, priority is given to patients with severe heart failure. Patients whose health deteriorates during the waiting period will be kept alive by artificial heart care systems until an organ is found.

What should I pay attention to while waiting for a heart?

 

Patients awaiting a heart transplant should be prepared at all times, both mentally and physically, for a transplant operation. They need to take their medication completely and on time. These patients should avoid crowded environments, pay attention to personal hygiene and undergo regular check-ups, as they are prone to infections. It must be possible for the patient and his relatives to be contacted by telephone at any time, as in the case of a heart transplant, it is not possible to schedule the operation in advance; therefore, they must be prepared to report to the hospital as soon as they are contacted by telephone.

 

What happens when a suitable heart is found for a transplant?

 

When a healthy person who has previously made the decision to donate their organs dies, some of their organs, such as the heart, liver, and kidneys, continue to function for a short period of time. When the anesthetist, neurologist and cardiologist determine that the person has died, their relatives will be asked to approve the organ donation. The person whose relatives approve the organ donation after her death is registered as an organ donor at the organ transplant coordination centers administered by the Ministry of Health, in order to find a suitable transplant beneficiary. Patients with heart failure on the waiting list for whom a suitable donor has been found will be called to the hospital immediately, if they are being monitored at home. In the case of patients who are hospitalized for a heart transplant and for whom a suitable donor has been found, the necessary preparations will begin immediately. After all the preparations have been completed, part of the transplant team goes to the respective center in order to prepare the donor’s heart. The other part of the team prepares the transplant recipient for the transplant operation. The heart transplant operation will be performed when both the recipient of the transplant and the donor are ready for it.

How to perform a heart transplant operation? What happens after surgery?

 

A heart transplant operation takes about 5-6 hours if there are no complications. After the operation, the patient is transferred to intensive care. When all the patient’s vital signs return to normal, he is disconnected from the ventilator. After the operation, patients have to stay in intensive care for 2-3 days, and then they are transferred to a special ward, and a member of his family has to stay with him permanently. The duration of hospitalization is about 15-20 days after surgery. After performing a biopsy to check if the tissue is rejected, the patient is discharged.

 

What is a heart biopsy? When is it done?

 

Cardiac biopsy is still the most effective way to check for tissue rejection after a heart transplant. The doctor inserts a catheter guided through the groin or vein from the neck to the heart to collect samples from the heart tissue. Samples are sent to the pathology department to check if the tissue is rejected and to determine the degree of rejection, if any. Cardiac biopsy is performed on the fifteenth day after transplantation. It is performed 4 to 6 times during the first year after the transplant, under the supervision of the medical team that monitored the patient. The frequency of biopsies decreases in the coming years, but it can also increase if necessary.

What does tissue rejection mean?

 

Tissue rejection is the recipient’s immune response to the donor’s heart. There are three degrees of rejection: mild, moderate and severe rejection. The content and dose of immunosuppressive therapy are adjusted according to the degree of reaction.

 

Is it possible for the patient to return to a normal life after a heart transplant?

 

The patient should regain his strength soon after the heart transplant, so that he is able to perform any physical activity, especially from the end of the second month after the transplant, when the tissue is largely healed. The patient will definitely need physical therapy and recovery, as the muscles of the arm and leg have been weakened for several years due to heart failure. One year after the transplant, the patient should be able to return to work, part-time or full-time.

 

How to perform an operation on the artificial heart support mechanism? What happens after the operation?

Artificial heart support mechanisms are classified into two implantable groups: miniature and paracorporeal. The choice of one of these depends on the severity of the heart failure and the general health of the patient. Although the operations on the artificial heart support mechanism differ depending on the type of mechanism implanted, this type of operation takes 3-6 hours, if there are no complications. The patient will wake up after anesthesia in a private intensive care unit and will be disconnected from the ventilator when all vital signs of the patient return to normal. After the operation, the patients have to stay in intensive care for 2-3 days, and then they are transferred to their private salon, and a member of his family has to stay with him permanently. The duration of hospitalization is about 20-25 days after surgery. Throughout the use of this mechanism, the patient should take blood thinners and perform regular blood tests. The dose of these medicines will be determined by your doctor.

 

Who can benefit from a completely artificial heart?

A completely artificial heart is a mechanism implanted in the body that replaces the diseased heart. There are two types of artificial hearts, each with a well-defined purpose. The first type, the completely artificial heart Syncardia Cardiowest, is the most used to keep patients temporarily alive, until the time of the heart transplant. It is the latest version of the artificial heart developed by Dr. Kolff and Dr. Jarvik about 50 years ago. It has been used with a success rate of over 90% for hundreds of patients. This is the most widely used artificial heart. The other type of artificial heart is the AbioCor TAH permanent intracorporeal electric motor.

 

Are state costs related to heart transplant surgery and the artificial heart care mechanism reimbursed by the state?

 

A limited number of health organizations are licensed and audited by the state for heart transplantation programs and the artificial heart care mechanism. There is a package on payment systems available from the Social Security Institution (SSI) which includes costs related to heart transplant surgery and artificial heart care, inpatient care and treatment, intensive care and hospitalization for patients. which are registered in the SSI.