Orthotopic heart transplantation

347 June 2012, Vol. 102, No. 6 SAMJ Orthotopic heart transplantation Christiaan Barnard and his team performed the world’s first human-tohuman heart transplant operation on 3 December 1967. It was a major historical event and a significant breakthrough for medical science. This and subsequent events received front-page media coverage around the world for months on end, describing all aspects in detail and giving progress reports on the postoperative course of the patients. Between December 1967 and November 1974, exclusively orthotopic heart transplantation was performed. Ten such heart transplants were done, and a heart and lung transplant was also performed in 1971.1-6 Of the 10 patients who received orthotopic heart transplants, 4 lived for more than 18 months; 2 of them became long-term survivors, one living for over 13 years and the other for over 24 years. This last patient is remarkable not only for the length of his survival but for excellent recovery from the operation in spite of severe cardiac atherosclerosis at the time of the surgery. Within 3 months he had returned to work and did not miss a single day’s work until he retired 15 years later. He died from a cerebrovascular accident after unsuccessful peripheral vascular surgery and lower limb amputations. In the 1971 transplantation of a heart and both lungs, the heart was placed in the orthotopic position and the lungs were transplanted separately at the left and right main bronchi. The patient died 23 days later from pneumonia and bronchopleural fistula complications. This operation was considered quite an achievement, as two such operations were performed in the USA at about the same time, but the patients did not survive longer than a day or two. This early experience established sound criteria for the selection of recipients who would derive maximum benefit from heart transplantation. Experience was also obtained in methods of diagnosis and treatment of acute rejection.7,8