Cardiac orthotopic transplantation

Cardiac transplantation is the ultimate therapeutic option in end-stage CHF. Orthotopic cardiac transplantation is the surgical technique of choice, whereas heterotopic cardiac transplantation is performed primarily when there is high resistance in the pulmonary circulation of the recipient (and a heart-lung transplantation is impossible), the donor heart is too small, or in selected cases with acute but potentially reversible heart failure. In orthotopic transplantation the donor heart is joined to the recipients atria, aorta, and pulmonary artery. In heterotopic transplantation, the donor heart is implanted into the right thoracic cavity and anastomosed with the recipient s heart in a complex maimer in such a way that the donor heart takes over most of left ventricular output, while the recipient s heart continues to ensure right ventricular output. 

Orthotopic cardiac transplantation is the best therapeutic option for patients with chronic irreversible New York Heart Association Class IV HF, with a 10-year survival of approximately 50% in well-selected patients. 

Wilson RF et al Regional differences in sympathetic reinnervation after human orthotopic cardiac transplantation. Circulation 1993 88 165. [PMID 8319329]... 

Absolute contraindications to orthotopic cardiac transplantation include the presence of an active infection (except in the case of an infected ventricular assist device, which is an indication for urgent transplantation) or the presence of other diseases (i.e., mahgnancy) that may limit survival and/or rehabihtation and severe, irreversible pulmonary hypertension. 

Murali, S., Kormos, R. L., Uretsky, B. F., et al. (1993). Preoperative pulmonary hemodynamics and early mortality after orthotopic cardiac transplantation The Pittsburgh experience. Am. Heart J. 126, 896-904. 

Sokal EM, et al. Progressive cardiac failure following orthotopic liver transplantation for type IV glycogenosis. Eur J Pediatr. 1992 151(3) 2(X)-3. 

The technique of total orthotopic cardiac transplantation was introduced by Yacoub et al. (1990) and Dreyfus et al. (1991) and in it both donor atria remain, intact with separate anastomoses of... 

Antretter H, Poelzl G, Margreiter J et al (2002b) Successful transfer of a cardiac allograft from a heterotopic to an orthotopic position 16 years after heart transplantation. Transplantation 74 540-543... 

Deleuze PH, Benvenuti C, Mazzuccotelli JP et al (1995) Orthotopic cardiac transplantation with direct caval anastomosis is it the optimal procedure J Thorac Cardiovasc Surg 109 731-737... 

Melton IC, Gilligan DM, Wood M A et al (1999) Optimal cardiac pacing after heart transplantation. PACE 22 1510-1527 Meyer SR, Modry DL, Bainey K et al (2005) Declining need for permanent pacemaker insertion with the bicaval technique of orthotopic heart transplantation. Can J Cardiol 21 159-163... 

Henry DA, Corcoran HL, Lewis TD et al (1989) Orthotopic cardiac transplantation evaluation with CT. Radiology 170 343-350... 

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