Overview of Heterotopic Cardiac Transplantation

Dr. Christiaan Barnard made history in 1967 when he performed the first human-to-human heart transplant. The procedure involved replacing the damaged heart of the patient with the healthy heart of donor, a surgery called an orthotopic heart transplant. Heart transplant surgery continued to evolve and in 1974, Dr. Barnard performed the first heterotopic cardiac transplant.

Definition

• Heterotopic cardiac transplantation, or "piggy-back" transplantation, is an operation in which a patient receives a donor heart while retaining his original one. The new heart assists the ailing one.

Purpose

• The heterotopic transplant served patients well before the discovery of anti-rejection drugs. If the patient's body rejected the new heart, the old one remained as a backup until doctors found a replacement. The discovery and use of anti-rejection drugs decreased the significance of the procedure's greatest advantage. Since orthotopic transplants produced more favorable outcomes, it became the technique of choice.

Incidence

• Currently, few hospitals conduct heterotopic heart transplants. According to an article made available by the National Institute of Health, more than 1,000 cardiac surgical centers perform heart transplantation worldwide, yet only 50 have experience in performing heterotopic cardiac procedures.

Current Uses

• Though rare, heterotopic cardiac transplantation remains the best option in some circumstances. Sometimes the only available donor heart is significantly smaller than that required by the recipient. In such cases, the donor heart serves as an auxiliary pump. Patients with irreversible pulmonary hypertension, a condition in which blood pressure is high in the arteries of the lungs and right side of the heart, may also benefit.