Ahmed Talha, Jain Ankit
University Of Maryland
Augusta University
Patients with advanced heart failure requiring mechanical circulatory support and inotropic support have a poor prognosis. Cardiac transplantation in a selected cohort of such patients can be the treatment of choice. The early experience with heart transplants was disappointing. In 1967, the first patient to receive a heart transplant died of an overwhelming infection after 17 days. However, with the advent of immunosuppressive therapies and a better understanding of human anatomy and surgical techniques, cardiac transplantation started gaining popularity in the 1990s. The International Society for Heart and Lung Transplantation (ISHLT) reported maximum transplants during the period of 1993-2004; however, in recent years, the numbers reported have grown even further. With well-defined indications now set forth by the American College of Cardiology/American Heart Association/Heart Failure Society of America (ACC/AHA/HFSA) and European Society of Cardiology (ESC) in collaboration with ISHLT, more people are on the waiting list than is the availability of the organ itself. This review will focus on the updated guidelines on indications and contraindications of a heart transplant, commonly utilized techniques, post-transplant immunosuppression, and common complications of the procedure.
需要机械循环支持和正性肌力支持的晚期心力衰竭患者预后较差。在这类经过挑选的患者队列中，心脏移植可能是首选治疗方法。早期心脏移植的经验并不理想。1967年，首例接受心脏移植的患者在术后17天死于严重感染。然而，随着免疫抑制疗法的出现以及对人体解剖学和手术技术的更深入了解，心脏移植在20世纪90年代开始受到欢迎。国际心肺移植学会（ISHLT）报告称，1993年至2004年期间心脏移植数量最多；然而，近年来，报告的移植数量进一步增加。随着美国心脏病学会/美国心脏协会/美国心力衰竭学会（ACC/AHA/HFSA）与欧洲心脏病学会（ESC）联合国际心肺移植学会（ISHLT）明确了心脏移植的适应症，现在等待名单上的人数超过了可供移植的器官数量。本综述将重点关注心脏移植适应症和禁忌症的最新指南、常用技术、移植后免疫抑制以及该手术的常见并发症。
