heart transplantation

1. Relation between Norman
and Heart transplantation
By
dinakaran soundara paulraj
group-18

2. Norman shumway
• Norman Edward Shumway (February 9, 1923 – February 10, 2006
was a pioneer of heart surgery at Stanford University.
Early life
• Shumway was born in Kalamazoo, Michigan. He attended the University of
Michigan for one year as an undergraduate until he was drafted by the Army
in 1943, which sent him to John Tarleton Agricultural College in
Stephenville, Texas for engineering training.
• He received his M.D. from Vanderbilt in 1949.
• He did his residency at the University of Minnesota under Walt Lillehei
alongside future fellow transplantation pioneer Christian Barnard, and was
awarded a surgical doctorate in 1956.
• In his later years Shumway was the first recipient of the Lifetime Achievement
Award given by the International Society for Heart & Lung Transplantation. He
also received the 1994 Lister Medal.
• Honorary degree, University of Pavia,1998.
He died of lung cancer in Palo Alto in 2006, on the day after his 83rd birthday.

3. Heart transplantation
• Norman Shumway is widely regarded as the father of heart
transplantation although the world's first adult human heart transplant
was performed by a South African cardiac surgeon, Christiaan
Barnard utilizing the techniques developed and perfected by Norman
Shumway and Richard Lower.
• Barnard performed the first transplant on Louis Washkansky on
December 3, 1967 at the Groote Schuur Hospital in Cape Town South
Africa.
• Adrian Kantrowitz performed the first pediatric heart transplant in the
world on December 6, 1967 at Maimonides Hospital (now Maimonides
Medical Center) in Brooklyn, New York barely three days after
Christiaan Barnard.
• Norman Shumway performed the first adult heart transplant in the
United States on January 6, 1968 at the Stanford University Hospital.
• In the 1970s he and his team refined the operation, tackling the
problems of rejection and the necessity for potentially dangerous
drugs to suppress the immune system. In particular he pioneered the
use of cyclosporine, instead of traditional drugs, which made the
operation safer.

4. • A heart transplant, or a cardiac transplant, is a surgical transplant procedure
performed on patients with end-stage heart failure or severe coronary artery disease.
• As of 2008 the most common procedure was to take a working heart from a recently
deceased organ donor (cadaveric allograft) and implant it into the patient.
• The patient's own heart is either removed (orthotopic procedure) or, less
commonly, left in place to support the donor heart (heterotopic procedure); both were
controversial solutions to an enduring human ailment.
• Post-operation survival periods averaged 15 years.Heart transplantation is not
considered to be a cure for heart disease, but a life-saving treatment intended to
improve the quality of life for recipients.
Stitching of the implant donor heart to patient
Need and procedure of transplant

5. epidemiology
• Worldwide, about 3,500 heart transplants are performed annually. The vast
majority of these are performed in the United States (2,000-2,300 annually).
• Cedars Sinai Medical Center in Los Angeles, California currently is the
largest heart transplant center in the world and has performed the most
number of yearly heart transplants in the last four consecutive years
performing 119 transplants in 2013 alone.
• Xenografts(research into the transplantation of non-human hearts into
humans after 1993) from other species and man-made artificial hearts are
two less successful alternatives to allografts.
NUMBER OF HEART
TRANSPLANTS
REPORTED BY YEAR

6. Pre-operative
• A typical heart transplantation begins when a suitable donor heart is
identified. The heart comes from a recently deceased or brain dead
donor, also called a beating heart cadaver.
• The patient is contacted by a nurse coordinator and instructed to
come to the hospital for evaluation and pre-surgical medication.
• At the same time, the heart is removed from the donor and
inspected by a team of surgeons to see if it is in suitable condition.
Learning that a potential organ is unsuitable can induce distress in
an already fragile patient, who usually requires emotional support
before returning home.
The patient must also undergo emotional, psychological, and physical
tests to verify mental health and ability to make good use of a new
heart. The patient is also given immunosuppressant medication so that
the patient's immune system does not reject the new heart.

7. Operative
• Once the donor heart passes inspection, the patient is taken into the operating
room and given a general anaesthetic.
• Either an orthotopic or a heterotopic procedure follows, depending on the
conditions of the patient and the donor heart.
Orthotopic procedure
• The orthotopic procedure begins with a median sternotomy, opening the chest
and exposing the mediastinum. The pericardium is opened, the great vessels
are dissected and the patient is attached to cardiopulmonary bypass.
• The donor's heart is injected with potassium chloride (KCl). Potassium chloride
stops the heart beating before the heart is removed from the donor's body and
packed in ice. Ice can usually keep the heart usable four to six hours depending
on preservation and starting condition.
• The failing heart is removed by transecting the great vessels and a portion of the
left atrium. The patient's pulmonary veins are not transected; rather a circular
portion of the left atrium containing the pulmonary veins is left in place.
• The donor heart is trimmed to fit onto the patient's remaining left atrium and the
great vessels are sutured in place. The new heart is restarted, the patient is
weaned from cardiopulmonary bypass and the chest cavity is closed.
The orthotopic procedure was developed by Shumway and Lower at Stanford-Lane
Hospital in San Francisco in 1958.

8. Heterotopic procedure
• In the heterotopic procedure, the patient's own heart is not removed. The new heart
is positioned so that the chambers and blood vessels of both hearts can be
connected to form what is effectively a 'double heart'.
• The procedure can give the patient's original heart a chance to recover, and if the
donor's heart fails (e.g., through rejection), it can later be removed, leaving the
patient's original heart.
• Heterotopic procedures are used only in cases where the donor heart is not strong
enough to function by itself (because either the patient's body is considerably larger
than the donor's, the donor's heart is itself weak, or the patient suffers from
pulmonary hypertension).
Post-operative
• The patient is taken to the ICU to recover. When they wake up, they move to a
special recovery unit for rehabilitation.
• The duration of in-hospital, post-transplant care depends on the patient's
general health, how well the heart is working, and the patient's ability to look
after the new heart.
• After 1-2 weeeks the patientwill be release, the patient returns for regular check-
ups and rehabilitation. They may also require emotional support. The frequency
of hospital visits decreases as the patient adjusts to the transplant.
• The patient remains on immunosuppressant medication to avoid the possibility
of rejection. Since the vagus nerve is severed during the operation, the new
heart beats at around 100 beats per minute unless nerve regrowth occurs.

9. Complications
Post-operative complications include
 infection,
 sepsis,
 organ rejection,
 as well as the side-effects of the immunosuppressive medication.
Since the transplanted heart originates from another organism, the
recipient's immune system typically attempts to reject it. The risk of
rejection never fully goes away, and the patient will be on
immunosuppressive drugs for the rest of his or her life, but these
may cause unwanted side effects, such as increased likelihood of
infections, like fevers, unusual pains, or any new feelings.
 Recipients can get kidney disease from a heart transplant.
 Many recent advances in reducing complications due to tissue
rejection stem from mouse heart transplant procedures

10. Notable recipients
• At the time of his death on August 10, 2009, Tony Huesman was the world's longest living
heart transplant recipient, having survived for 31 years. Huesman received a heart in 1978
at the age of 20 after viral pneumonia severely weakened his heart. Huesman died of
cancer.[11] The operation was performed at Stanford University under heart transplant
pioneer Dr. Norman Shumway.[12]
• Kelly Perkins climbs mountains around the world to promote positive awareness of organ
donation. Perkins was the first recipient to climb the peaks of Mt. Fuji, Mt. Kilimanjaro, the
Matterhorn, Mt. Whitney, and Cajon de Arenales in Argentina in 2007, 12 years after her
surgery.[citation needed]
• Twenty-two years after Dwight Kroening's heart transplant, he was the first recipient to
finish an Ironman competition.[13]
• Fiona Coote was the second Australian to receive a heart transplant in 1984 (at age 14)
and the youngest Australian. In the 24 years after her transplant she became involved in
publicity and charity work for the Red Cross, and promoted organ donation in
Australia.[citation needed]
• Race car driver and manufacturer Carroll Shelby received a heart transplant in 1990.[14]
• Kenneth Claus, transplanted September 23, 1988, Shands Hospital, Gainesville, Florida
was ranked by Rate My Professors as one of the top 25 professors for the U.S. in 2009 -
2010: he was 19th. He still teaches 3 semesters a year at Florida International University,
Miami, Fl.

11. Artifical heart
• An artificial heart is a man-made device that is
implanted into the body and replaces a person‟s
biological heart (Wikipedia).
• An artificial heart is representative of modern
technology in medicine.
• An artificial heart is a medical instrument that is was
created in the 1950‟s.
• The estimated cost is $150,000 per implanted artificial
heart, which can increase the U.S. medical bill by
anywhere from $2.5 to $3 million (Jarvik & Callahan,
1986).
• The use of an artificial heart to replace heart
transplants is controversial.

12. Jarvik 7
• Jarvik 7 was the first artificial heart.
• The first patient received the heart in 1982 and
consequently died 112 days later from technical problems.
• It took years to conquer, but the problems associated with
the original Jarvik 7 have been worked out in order for the
heart to benefit others.
• It can support circulation and improve health in even
extremely sick people (Jarvik & Callahan, 2007).
• Robert Jarvik created and experimented with the first
artificial heart in the 1950‟s.
• Jarvik received a patent for his work in 1963.
• The first implantation of an artificial heart was done in April
4, 1969 at the Texas Heart Institute in Houston (Wikipedia,
2007).

13. Jarvik vs Norman
• Using an artificial heart in medical procedures is a
controversial issue. However, the demand for real hearts
is growing and the supply is not. Using an artificial heart
may be beneficial to many because it can help save lives.
• There is always a higher demand for heart transplants
compared to the number of hearts available. An artificial
heart will lower the need for heart transplants.

14. NOW A DAYS
• French biomedical firm Carmat said that it had begun the
first human trial of its prototype artificial heart, which aims
at overcoming shortages of organs available for transplant.
• The Carmat product aims to provide a longer-term solution
to bridge the wait for a donor heart and enable hospitalised
patients to return home and maybe even resume work.
• The artificial heart, a self-contained unit implanted in the
patient‟s chest, uses soft “biomaterials” and an array of
sensors to mimic the contractions of the heart.
• The patient had received his artificial heart on Dec. 18,2013
in a work first performed after the French government gave
its green light to the operation in September.
• “Seventy-five days after the implant of the first Carmat
artificial heart bioprosthesis in a 76-year-old man with a
terminal heart disease, the patient died on March 2, 2014,”
the Georges-Pompidou European Hospital said.

15. conclusion
• Nearly 100,000 people in Europe and the United
States are in need of a heart transplant, according to
Carmat.
• A U.S. rival to Carmat, an artificial heart called
AbioCor, is authorised in the United States for
patients with end-stage heart failure or life
expectancy of less than 30 days, who are not
eligible for a natural heart transplant and have no
other viable treatment options.
• If we invent a artifical heart, we don‟t want donor or
we didn‟t die for heart diseases.
• Another thing thing andtill we found artifical heart,we
must aware the people to donate organs

16. References
• Reiner Körfer (interviewee) (2007). The Heart-Makers: The
Future of Transplant Medicine (documentary film). Germany:
LOOKS film and television.
• Glick, Shav (31 January 1996). "Kidney Transplant a Success for
Shelby". Los Angeles Times.
• "William G. McGowan: Monopoly Buster". Entrepreneur. October
10, 2008. Retrieved September 7, 2012.
• Sandeep Jauhar, M.D., Ph.D.: The Artificial Heart. New England
Journal of Medicine (2004): 542–544.
• J. Wei, K. K. Cheng, D. Y. Tung, C. Y. Chang, W. M. Wan, Y. C.
Chuang: Successful Use of Phoenix-7 Total Artificial Heart.
Transplantation Proceedings, 1998, 30:3403-4.
• Berger, Eric. "New artificial heart 'a leap forward'". Houston
Chronicle. Retrieved 23 March 2011.
• #A new pulsatile total artificial heart using a single centrifugal
pump., K. Imachi, T. Chinzei, Y. Abe, K. Mabuchi, K. Imanishi, T.
Yonezawa, A. Kouno, T. Ono, K. Atsumi, T. Isoyama, et al..
Institute of Medical Electronics, Faculty of Medicine, University of
Tokyo, Japan.
• Mitka, Mike. "Midwest Trials of Heart-Assist Device." Journal of
the American Medical Association 286.21 (2001): 2661.
• Bishay, R. The „ Mighty Mouse‟ Model in Experimental Cardiac
Transplantation. Hypothesis 2011, 9(1): e5.