Be Still My Beating Heart… Then Come Back to Life

Portable Heart Perfusion System
Some 47 years ago doctors pioneered the world’s first human heart transplant surgery. Christiaan Barnard performed the first successful human-to-human transplant in South Africa after several years of experimentation on animals. 

The most common procedure today is to take a working heart from a recently deceased organ donor (cadaveric allograft) and implant it into the patient, but now surgeons in Australia report that they have performed the first heart transplant using a so-called “dead heart”. 

A team at St Vincent's Hospital in Sydney has succeeded in reviving and then transplanting hearts that had stopped beating for up to 20 minutes. This breakthrough should reduce the shortage of donor organs by extending the window of opportunity that surgeons have to locate and utilize hearts. Normally, beating hearts are taken from patients declared brain-dead, kept on ice for around four hours and then transplanted to patients; experts estimate the development could save 30% more lives.

Prof Peter MacDonald, head of St Vincent's heart transplant unit, said: “This breakthrough represents a major inroad to reducing the shortage of donor organs.” 

Device that keeps hearts beating
The novel technique involves taking a heart that had stopped beating and reviving it in a machine known as a Portable Heart Perfusion System or a “heart in a box”.

The heart is kept warm, the heartbeat is restored and a nourishing fluid helps reduce damage to the heart muscle. The preservation solution reportedly took 12 years to develop.

Similar methods of warming and nourishing organs before transplant have been used to improve the quality of lung and liver transplants.

The St Vincent’s Hospital team has successfully completed three transplants using this technique. Patient Michelle Gribilas, a 57-year-old who had congenital heart failure explained that she was “very sick” prior to her operation. “Now I'm a different person altogether. I feel like I'm 40 years old,” she said.

The heart transplant procedure usually involves either removing the patient's own heart either (orthotopic procedure) or, less commonly, leaving it in place to support the donor heart (heterotopic procedure).

Pioneering heart transplants

Although Christiaan Barnard is credited with the first successful heart transplant, many consider Norman Shumway to be the father of this procedure. Barnard used techniques pioneered by Shumway and Richard Lower

World's First Heart TransplantBarnard performed the first transplant on Louis Washkansky on 3 December, 1967 at the Groote Schuur Hospital in Cape Town, South Africa and was followed shortly afterwards by Adrian Kantrowitz who performed the world’s first pediatric heart transplant on 6 December 1967, at Maimonides Hospital in Brooklyn, New York.

Shumway performed the first adult heart transplant in the United States on 6 January 1968, at the Stanford University Hospital

Worldwide, some 3,500 heart transplants are performed annually and the vast majority take place in the United States (2,000-2,300 annually). On average, patients survive for 15 years. In comparison, Washkansky, a 54-year-old grocer suffering from diabetes and incurable heart disease, lived for only 18 days, finally succumbing to pneumonia as a result of the immunosuppressive drugs he was given to combat rejection of the donor heart. 

Cardiovascular disease (CVD) remains the main cause of death in Europe, according to the European Cardiovascular Disease Statistics, 2012 edition.

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