Synonym
The abbreviation HTX is commonly used in the medical sector. In the English-speaking world it is called heart transplantation.
Introduction
A heart transplantation means the transplantation of the heart of an organ donor into a recipient. In Germany, only a person who has been reliably diagnosed as brain dead can serve as an organ donor. In order to decide whether one would like to be considered as a donor after one’s death, one can record this on an organ donor card.
The first heart transplantation worldwide was performed in Cape Town in 1967, but the patient died shortly after the operation. The first heart transplantation in Germany took place two years later in Munich. But this transplanted patient also died a few hours after the operation.
Only when a new immunosuppressive agent (Ciclospoprin A) was developed to suppress the immune response, a new attempt at heart transplantation was dared. This was in 1961, and this time it was successful in the long term. For some years now, 300 to 400 heart transplantations have been performed in Germany every year.
The number of patients who are registered for such a transplant every year, i.e. who are on the heart transplant list, is almost twice as high. Accordingly, almost 1000 seriously ill patients are currently waiting for a donor heart. However, the waiting time for a new heart is 6 to 24 months, which is significantly less than the waiting time for a new kidney (4-5 years).
There are currently almost 8000 patients on the waiting list for a kidney. After a successful heart transplantation, the one-year survival rate is about 80%; after five years, about 60-70% of transplanted patients are still alive. Today, the 10-year survival rate is about 40-50 %.
Indication
The indication for heart transplantation is heart failure (cardiac insufficiency) in stage IV (4) according to NYHA, which can no longer be positively influenced conservatively (i.e. without HTX). Numerous criteria are taken into account when assessing the necessity of a heart transplantation, and contraindications must also be excluded. According to the New York Heart Association (NYHA), heart failure is divided into 4 stages.
A patient with stage NYHA I has no symptoms, a patient with NYHA II complains of shortness of breath (dyspnea) and weakness under heavy exercise, a patient with NYHA III has such symptoms even under light physical exertion, and a patient with NYHA IV has a strong need for air even when resting and is no longer able to bear weight. Heart failure is a symptom that can be triggered by various diseases. By far the most common causes are coronary heart disease (CHD) and cardiomyopathy (heart muscle disease). Heart valve disease is also not a rare cause of cardiac insufficiency.
