Heart-lung transplantation: Technical aspects

Combined heart-lung transplantation was first applied clinically by Bruce Reitz and Norman Shumway at Stanford University on March 9, 1981. 1 The recipient was a 43-year-old woman with primary pulmonary hypertension. At the time, en bloc transplantation of a heart and lung was believed to be the only option to treat end-stage lung disease. 2 Attempts at transplanting isolated lungs had failed because of bronchial anastomotic problems. 3 In the following years a large number of patients around the world received combined heart-lung transplants for chronic obstructive pulmonary disease, 4 cystic fibrosis, 5 pulmonary fibrosis, or other end-stage lung disease. At one point, domino transplantation was suggested for patients who had normal cardiac function but needed lung replacement. 6 The heart was subsequently transplanted into a heart-only recipient. 4 In the 1990s this practice changed when single- and sequential double-lung transplantation proved to be a safe and valuable therapy. 3 Today, en bloc heart and lung transplantation is reserved for patients with severe heart disease and end-stage lung disease. This category of patients may include those in whom one disease (for example, sarcoidosis or pulmonary hypertension 7 ) has destroyed both the heart and lung and those with end-stage heart disease (such as ischemic disease) together with end-stage lung disease (such as chronic obstructive pulmonary disease) of separate origin. Finally, Eisenmenger syndrome develops in a significant number of patients with congenital heart disease and may require a combined heart-lung transplant. 8 Combined heart-lung transplantation has also been suggested for Kartagener syndrome because of the complex anatomy. We and others have successfully used sequential double-lung transplantation in these cases. 9