Publication Date

6-1-2019

Journal

The Texas Heart Institute Journal

DOI

10.14503/THIJ-17-6544

PMID

31708703

Publication Date(s)

June 2019

Language

English

PMCID

PMC6827470

PubMedCentral® Posted Date

6-1-2019

PubMedCentral® Full Text Version

Post Print

Published Open-Access

yes

Keywords

Follow-up studies, graft survival, heart failure/surgery, heart transplantation/methods/physiology, HLA antigens/analysis, reoperation, survival analysis, time factors, transplant recipients, transplantation, heterotopic, treatment outcome

Abstract

Substantial technological advances in mechanical circulatory support have caused a shift in the management of end-stage heart failure. From the 1970s through the 1990s, heterotopic heart transplantation was routinely performed in patients in whom orthotopic transplantation was likely to fail. Heterotopic heart transplantation is now performed less often because modern mechanical circulatory assist devices are routinely used as bridges to orthotopic transplantation; regardless, the operation has helped numerous patients who would not otherwise have received adequate allografts. We describe the case of a man with idiopathic nonischemic cardiomyopathy who, at age 17, was given an ABO- and size-matched heterotopic allograft that was a complete human leukocyte antigen mismatch. The graft functioned normally for 20 years until the patient had a myocardial infarction that necessitated placement of a coronary artery stent. Subsequent treatments involved many interventions, including insertion of an intra-aortic balloon pump, medical therapy for heart failure, implantation of a total artificial heart, and, ultimately, orthotopic transplantation. To our knowledge, our patient is the longest surviving recipient of a heterotopic heart transplant, with a remarkable 25-year graft survival despite poor histocompatibility and an almost complete lack of native heart function. The strategies used for his treatment make him a living case study that can add valuable information to the history of cardiac support.

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