Orthotopic Heart Transplantation

Orthotopic heart transplantation is a surgical procedure where a diseased or failing heart is replaced with a healthy donor heart. The term "orthotopic" refers to the fact that the new heart is placed in the same location as the original heart.

Indications

Orthotopic heart transplantation is typically performed on patients with end-stage heart failure, which can be caused by a variety of conditions, including:

• Coronary artery disease
• Cardiomyopathy (diseases of the heart muscle)
• Heart valve disorders
• Congenital heart defects
• Myocarditis (inflammation of the heart muscle)

Surgical Procedure

The surgical procedure for orthotopic heart transplantation involves the following steps:

1. The patient is placed on a heart-lung machine, which takes over the function of the heart and lungs during the surgery.
2. The surgeon makes an incision in the chest and removes the diseased heart, leaving the back of the left atrium and the pulmonary veins intact.
3. The donor heart is then implanted, connecting it to the recipient's blood vessels and atria.
4. The surgeon connects the donor heart to the recipient's aorta, pulmonary artery, and other major blood vessels.
5. The heart-lung machine is then removed, and the new heart begins to function on its own.

Post-Operative Care

After the surgery, the patient is taken to the intensive care unit (ICU) for close monitoring. The patient will require:

• Immunosuppressive medications to prevent rejection of the new heart
• Monitoring of cardiac function and blood pressure
• Pain management
• Respiratory therapy to support breathing

Risks and Complications

As with any major surgery, orthotopic heart transplantation carries risks and potential complications, including:

• Rejection of the new heart
• Infection
• Bleeding or hemorrhage
• Stroke or neurological damage
• Kidney or liver dysfunction

Outcomes and Prognosis

The outcomes and prognosis for patients undergoing orthotopic heart transplantation are generally good, with:

• A 1-year survival rate of approximately 85-90%
• A 5-year survival rate of approximately 70-80%
• Improved quality of life and functional capacity

Follow-Up Care

After discharge from the hospital, patients will require regular follow-up care with their cardiologist and transplant team to monitor:

• Cardiac function and rejection status
• Immunosuppressive medication levels and adjust as needed
• Overall health and well-being