Orthotopic cardiac/heart transplantation

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. 

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. 

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. 

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... 

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... 

---