Transplantation

Surgeries

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 History
1933 – Heterotopic - Animal model - Mann

1950 – Orthotopic – Animal model

1958 – Goldberg and coworkers – Success

1963 – First human LUNG TRANSPLANT –

Hardy

1967 - 68 – Successful human - human heart

transplant – Christian Barnard.
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 Indications for transplantations

Orthotopic heart Heterotopic heart

 Cardiomyopathy  Patients with high
 CAD pulmonary vascular
 CHD resistance.
 Valvular heart disease
 Cardiac Tumors
 Amyloidosis

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 Heart - Lung Single Lung
 CHD  Pulmonary fibrosis or other
◦ Eissenmenger’s Syndrome restrictive disease

 Cystic Fibrosis  Emphysema

 PrimaryPulmonary α antitrypsin deficiency

1
Hypertension
 Pulmonary vascular disease

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 Double Lung Thoracic organ repeat
transplantation

 Patient with an infectious  Bronchiolitis Obliterans

lung disease.
 Graft Failure
 Emphysema

 Severe Acute Rejection

 Primary Pulmonary
Hypertension  Airway Problems

 Transplant CAD

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Contraindications to transplantations
 Advanced age ( > 60 years)
 Severe vascular disease
 Irreversible hepatic or renal dysfunction
 Active infection
 Insulin requiring Diabetes mellitus
 Poor medical compliance
 Systemic disease which will significantly limits survival or
rehabilitation.
 Previous lung transplantation
 Resistance to antibiotic used to treat infection.

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Recipient selection for heart transplant
NYHA class IV or III heart disease
Vascular disease
No evidence of malignancy for > 5 yrs
No CI to drugs
Non alcoholic, smoker & substance abuse
Financial requirements
No active infection
Motivation to survive
Left ejection fraction >20%
Ambulatory with rehabilitation potential.
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 Recipient selection for lung transplant
No evidence of malignancy for > 5 yrs
Severe obstructive or restrictive lung disease
No contraindication to drugs
Non alcoholic, smoker or substance abuse
Ambulatory with rehabilitation potential
Financial requirements
No organisms in sputum

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 Donor Selection
Heart Donors
 Age < 40 years
 No H/O cardiac disease
 No present infection
 No HIV and Hepatitis B (+)
 No prolonged resuscitative
efforts applied prior to
death.
 ABO compatibility
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Lung Donors
 Age < 35 years
 CXR free of infiltrates
 Clear bronchoscopy
 No significant chest trauma
and pulmonary contusion.
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 Heart - Lung Donors
 Age < 40 years
 No major thoracic trauma
 No past H/O pulmonary disease
 No systemic or pulmonary infections
 Normal ABG
 Normal ECG
 Normal lung compliance
 Inotropic requirement <10 µgm/kg/min – dopamine or
dobutamine

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 Transportation of Donor heart
Put in ice cold Hartmann’s solution
Aorta is clamped
Medicut is inserted into the aorta and connected
to Hartmann’s containing 1 ampule of
Cardioplegia Infusion.
Leads to stopping of heart.

Transported in Hartmann’s solution packed in 3

sterile bags and put into a cool box filled with
ice.
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Surgical Procedures

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 Cardiac transplantation
 Heterotopic transplantation (piggyback technique)
 Incision – median sternotomy
 Donor heart is connected to native heart
 Donor Rt & Lt atrium – Recipient Rt & Lt atrium
 Ascending aorta are anastomosed together
 Pulmonary arteries are connected via Dacron tube graft
 4 atrias function as 2
 Venous return is shared between two hearts
 CO occurs independently

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 Advantage
◦ Ability of native heart to assist the donor heart with
CO

Disadvantage

◦ Presence of angina and arrhythmias

◦ Need for long term anticoagulation therapy
◦ Use of prosthetic graft for pulmonary artery anast.
◦ Higher mortality heart
◦ Increase in right lobe atelectasis due to compresion
from donor’s heart

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 Orthotopic transplantation
Incision – median sternetomy
Use of CPBM
Recipient heart is excised, leaving a sizable cuff
of Lt and Rt atrium
Aorta and pulmonary artery are dissected
Donor heart is prepared and anastomosed:
Left and right atrium to Lt and Rt atrial cuff
Pulmonary arteries and then aorta are
anastomosed

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 Lung transplantation
Double lung transplantation

 Pulmonary veins are detached from the heart with a cuff of

left atrium, pulmonary arteries are transected, and the
lungs are removed.
 Anastomoses of pulmonary artery followed by bronchial.

Single lung transplantation

 Incision– posterolateral thoracotomy

 Anastomosis of atria followed by pulmonary artery and
bronchial.
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 Heart – lung transplantation
 Incision – median sternotomy and ant. Pericaridectomy
 Use of CPBM
 Ascending aorta is clamped
 Heart and lungs are excised at the aorta just above the
aortic valve, the atrioventricular groove of Rt atrium,
across the trachea above the level of carina.
 Prepare the donor heart and lung
 Anastomosis of trachea, aorta, IVC and SVC
 Resuscitation of heart and lung.
 Closure of thoracic cavity.

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 Physiotherapy Management

CARDIAC REHABILITATION
◦ Phase 1
◦ Phase 2
◦ Phase 3
◦ Phase 4

PULMONARY REHABILITATION
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Thank You

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