Surgical Technique of Heterotopic Heart Transplantation

Abstract

Heterotopic heart transplantation has a long history in the experimental laboratory¹ (Chapter 1), but was not attempted clinically until 1974². Based on extensive experimental work by Losman and Barnard³, a form of heterotopic transplantation was carried out whereby the donor heart acted solely as a left ventricular assist device². This operation involved anastomoses between the donor and recipient left atria and aortae; donor coronary sinus venous return was drained via the donor right atrium and right ventricle into the recipient circulation by anastomosing the donor pulmonary artery to the recipient right atrium. Two such operations were performed. Both patients suffered recurrent attacks of recipient heart dysrhythmias, including ventricular fibrillation, during which time the donor heart supported the circulation alone, though with significant loss of blood pressure. As a result of this experience, the technique was modified to allow bypass and support of both recipient ventricles^{2, 4}.