What's New in Heart Transplantation

Podcast Transcript

Announcer:

Welcome to Cleveland Clinic Cardiac Consult, brought to you by the Sydell and Arnold Miller Family Heart, Vascular & Thoracic Institute at Cleveland Clinic.

Michael Zhen-Yu Tong, MD:

Good morning, my name is Michael Tong. I am the surgical director of heart transplantation and MCS at Cleveland Clinic. So I want to talk about what is new in heart transplantation. So the first human heart transplant was done in South Africa by Christian Barnard. This was in 1967. What you may not have known, was that the first heart transplant at Cleveland Clinic was just one year after, in 1968. So transplantation from the post-transplant standpoint, really hasn't changed all that much in the past 20 years. We, for the most part, still use the same medications we use today, as we always did. However, on the donor side, this is where we did make quite a few inroads. So if you look at, in the United States, all the donors that donate anything, it could be their lung, it could be a bone graph, it could be a kidney, etc., only about one out of every four of the donors, we end up taking their hearts. For many reasons. It could be age could be too advanced, they may have coronary disease, their heart function may not be all that good, compared to kidney and compared to liver, which takes about 70% of the organs from available donors. So there's a big gap in what we utilize, with the hearts that we utilize, versus the hearts that are discarded, but that nevertheless can still be suitable donors. So in the past, we would never take a donor who had hepatitis C, because we would give a recipient hepatitis C. And that's not something that we would want. But now we have treatment for all 20 subtypes of hepatitis C, and hence, it's no longer an ethical dilemma to give a recipient a heart from a donor that has hep C, because we will treat the hep C afterwards.

And it doesn't just controls the hep C, but it completely eradicates the hep C, so it's no longer in their blood, and they're no longer in the system. In the early days of COVID, we really didn't understand how COVID affected the heart, but it turns out that in the later strains of COVID, the heart just wasn't affected at all. And so we were one of the only programs at first that were taking hearts from COVID positive donors. And now all programs, almost all programs, will take COVID positive donor hearts. We will go up to age of 55 for donors, and we also have technology that will allow us to go much further distances. Historically, we would only go about 800 miles, which is about a two hour flight. Now we will go up to about 2,500 miles. So we can go to Alaska, we can go to San Diego, we can go to Puerto Rico, we can even go to Hawaii to procure hearts for our recipients.

And the last thing which has made the biggest impact, is DCD. So DCD stands for donation after cardiac death. So historically, when we took donors, they would have to be brain-dead. So brain-dead means you have to have no blood flow to the brain, for us to take that organ. However, very few patients that die, die of brain death criteria. So DCD essentially means there's another way for these donors to be recognized that they have died. If you take them off of life support, if their heart stops within 60 minutes, then we can still go ahead and take their heart. In the past, we have no idea if this heart will revive. But we have technology now, where we can take this heart, hook it onto a machine, blood will circulate through a machine, and you can have a heart that's beating inside the machine. And we can assess the heart. And if we're happy about the function of the heart, then we can go ahead and use it.

So if you look at the size of our program, combined, LVAD and transplant, we're third in the country. Our goal is to get to number one, our goal within the next three years, to get to 200 LVADs and transplants. We have the second highest complexity and risk, all the large programs, but the third best survival. So if you had your LVAD or transplant surgery here at the Cleveland Clinic, you had about a 40% less risk of mortality than if you had it in any other large program. If we compare ourselves to the other program, our three-year survival is 94%, and compared to the national average of 86%. So your risk of mortality is less than half. So in conclusion, future improvements are targeting a quality of life, and now we have many more hearts that are available to our recipients. Thank you.

Announcer:

Thank you for listening. We hope you enjoyed the podcast. We welcome your comments and feedback. Please contact us at heart@ccf.org. Like what you heard? Subscribe wherever you get your podcasts, or listen at clevelandclinic.org/cardiacconsultpodcast.