Heart transplantation

Heart transplantation is the final option to treat severe life-threatening heart failure that is not responsive to other forms of treatment. The most common indications for a heart transplant include disorders causing the myocardium to become thinner and irreversible myocardial injury caused by coronary artery disease. The indications have remained the same throughout the history of heart transplants.

In Finland, heart transplants are exclusively performed at HUCH where the first heart transplant was performed in 1985. By September 2012, a total of 441 heart transplants had been completed on adult patients.

In recent years, the average number of completed heart transplants has been 16 to 20 per year, although the actual need is higher – it is currently 25 to 30. Pediatric heart transplantations are completed at the Children's Hospital.

With improved preventive care and advances in pharmaceutical, machine and surgical therapies, severe cardiac failure now occurs more in older age groups than previously. The number of heart transplantations indicated by coronary artery disease has decreased, and currently cardiomyopathies are the most common indications for heart transplantations in Europe.

Patient assessment

To ensure a good prognosis, heart transplant patients must be assessed and the transplantation must be completed in time. Although conservative treatment forms can be successfully applied longer than before, a prolonged period of pharmaceutical therapy preceding a heart transplant is likely to have a negative effect on the success of the transplantation, long and short-term recovery and long-term results. Correct timing is essential but difficult to determine. The optimal time is when cardiac function has irreversibly and profoundly deteriorated but has not yet caused any permanent damage to renal, hepatic or pulmonary function.

Several factors such as the severity of the cardiac disease, injuries to other organs caused by low cardiac output, sensitivity to arrhythmia, possible other diseases and response to pharmaceutical treatment affect the prognosis of insufficiency and determining the optimal transplantation time. Early assessment of the patient allows sufficient time to make all the necessary arrangements and to time the transplantation optimally.

Contraindications

Contraindications to a heart transplant include alcohol and drug addiction, smoking, drug misuse, inability to care for oneself, unstable mental health and poor treatment compliance. Other contraindications include old age (65 to 70 years and above), a recent cancer, serious infections, irreversible renal insufficiency or hepatic failure and pulmonary vascular resistance.

Results

Heart transplantations are regularly completed at HUCH, and the results are excellent even by international standards. Approximately 90% of the patients are alive one year after the operation and 85% five years after the operation.

After a heart transplant, the quality of life remains fair, and is on the same level with the general population. However, the side effects of immunosuppressants may have a negative effect on the quality of life.

A ventricular assist device (VAD) bridges the gap between cardiac failure and heart transplant

In recent years, the number of heart transplants has decreased due to the lack of donors. While on the waiting list, 25% to 40% of patients are mechanically treated for cardiac insufficiency. For some of these patients, a mechanical circulatory device, or a ventricular assist device (VAD), has provided relief from acute, life-threatening circulatory insufficiency, while for others a VAD has been implanted to avoid permanent organ failure before a suitable transplant can be found.