Heart Transplantation : The Present Status of Orthotopic and Heterotopic Heart Transplantation

It is a great pleasure for me to contribute a brief introduction to this volume, to which so many of my colleagues at Groote Schuur Hospital and the University of Cape Town Medical School have contributed. Though considerable advances have been made in preventing or treating the complications of heart transplantation, even today a transplant pro­ gramme remains a major undertaking for a hospital team. The acquisition of a sufficient number of donor hearts, the maintenance of viability of those hearts, and the prevention, diagnosis and treatment of acute and chronic rejection and infection remain major challenges to those caring for patients undergoing this operation. A transplant programme draws into it medical, surgical, nursing and paramedical staff from all quarters of the hospital and medical school, and requires sustained interest and dedication if patients are to be brought successfully through the procedure. If relevant experimental research is also to be carried out at such a centre, which in my opinion is essential, then an even greater number of highly skilled and creative people is required. A few of the authors of this book have been involved with the Groote Schuur heart transplant programme since its inception in December 1967 with the operation on Louis Washkansky. I am sure that none of them (nor I) had any idea of the public interest this operation would attract. Front Matter....Pages i-xiv Experimental Development and Early Clinical Experience....Pages 1-14 Selection and Management of the Recipient....Pages 15-22 Selection and Management of the Donor....Pages 23-38 Medico-legal Aspects....Pages 39-49 Donor Heart Storage....Pages 51-76 Immunological Aspects....Pages 77-94 Anaesthesia and Intraoperative Care, including Cardiopulmonary Bypass....Pages 95-101 The Surgical Techniques of Orthotopic and Heterotopic Heart Transplantation....Pages 103-127 Immediate Postoperative Care and Maintenance Immunosuppressive Therapy....Pages 129-145 Physiology and Pharmacology of the Transplanted Heart....Pages 147-156 Pathology of Acute Rejection....Pages 157-176 Diagnosis and Management of Acute Rejection....Pages 177-194 Infectious Complications....Pages 195-221 Malignant Neoplasia in the Immunocompromised Patient....Pages 223-233 Psychiatric Aspects....Pages 235-242 Pathology of Chronic Rejection....Pages 243-256 The Management of Chronic Rejection: Retransplantation....Pages 257-269 Other Complications of Transplantation and Immunosuppression....Pages 271-285 Results of Cardiac Transplantation and Factors Influencing Survival....Pages 287-303 Advantages and Disadvantages of Heterotopic Transplantation....Pages 305-319 Transplantation of the Heart and Both Lungs....Pages 321-340 The Future of Heart Replacement....Pages 341-349 Back Matter....Pages 351-369