A 6-YEAR EXPERIENCE OF HEART TRANSPLANTATION IN FEDERAL ALMAZOV NORTH-WEST MEDICAL RESEARCH CENTRE

Aim. To estimate the results of 6-year experience of heart transplantation (HT) in Federal Almazov North-West Medical Research Centre. Methods. From 2010 to 2015 we have performed 65 HT. Mean age was 44.3 ± 14 years old (from 10 to 64 years old). We used biventricular assist device (BIVAD, Berlin Heart Excor) support in 7 heart transplant candidates before HT. 19 patients (29%) received thymoglobulin, whereas 46 patients (71%) had basiliximab to induce immunosuppression.

Results. Extracorporeal membrane oxygenation machines were implanted in 5 patients (7.7%) after HT due to acute right ventricular failure. Suture annuloplasty (the Batista procedure) for tricuspid valve repair was carried out in 3 cases (4.6%). Venovenous hemodiafi ltration was used in 11 patients (16.9%). A total of 598 endomyocardial biopsies (EMB) were performed after HT. Evidence of cellular rejection (R1 and R2) was presented in 286 biopsies (48%). The 30-day in-hospital mortality rate was 3.1%. The 6-month survival rate after HT was 92%, 1-year – 91% and overall survival for the 6-year period of observation – 89.2%. Maximum observation period was 71 months.

Conclusions. The 6-year experience of HT in our Center has shown a high level of survival. BIVAD Excor support can be effectively used as a «bridge» to HT. Prevention of graft loss due to acute rejection in heart transplant recipients can be achieved only through regular EMB monitoring. The rate of viral infection increased in 2 months after HT.

1. Национальные рекомендации ОССН, РКО и РНМОТ по диагностике и лечению ХСН (четвертый пересмотр). Сердечная недостаточность. 2013; 14 (17): 379–472. Nacional’nye rekomendacii OSSN, RKO i RNMOT po diagnostike i lecheniyu HSN (chetvertyj peresmotr). Serdechnaya nedostatochnost’. 2013; 14 (17): 379–472.

2. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012. European Heart Journal. 2012; 33: 1787–1847.

3. The Registry of the International Society for Heart and Lung Transplantation: Thirtieth Offi cial Adult Heart Transplant Report – 2013; Focus Theme: Age. The Journal of Heart and Lung Transplantation. 2013; 32 (10): 951–964.

4. Трансплантология: Руководство для врачей / Под ред. В.И. Шумакова. М.: Медицинское информационное агентство, 2006. 400 c. Transplantologiya: Rukovodstvo dlya vrachej / Pod red. V.I. Shumakova. M.: Medicinskoe informacionnoe agentstvo, 2006. 400 c.

5. Трансплантология: итоги и перспективы. Том III / Под ред. С.В. Готье. М.–Тверь: Триада, 2012. 416 с. Transplantologiya: itogi i perspektivy. Tom III / Pod red. S.V. Got’e. M.–Tver’: Triada, 2012. 416 s.

6. Готье СВ, Мойсюк ЯГ, Хомяков СМ. Донорство и трансплантация органов в Российской Федерации в 2014 году. VII сообщение регистра Российского трансплантологического общества. Вестник трансплантологии и искусственных органов. 2015; 17 (2): 7–22. Got’e SV, Mojsyuk YaG, Homyakov SM. Donorstvo i transplantaciya organov v Rossijskoj Federacii v 2014 godu. VII soobshchenie registra Rossijskogo transplantologicheskogo obshchestva. Vestnik transplantologii i iskusstvennyh organov. 2015; 17 (2): 7–22.

7. Demikhov VP. Experimental Transplantation of Vital Organs. Haigh B. (trans). New York: Consultants’ Bureau, 1962.

8. Lower RR, Shumway NE. Studies on the orthotopic homotransplantation of the canine heart. Surg Forum. 1960; 11: 18.

9. Трансплантология: Руководство / Под ред. акад. В.И. Шумакова. М.: Медицина; Тула: Репроникс Лтд, 1995. 392 с. Transplantologiya: Rukovodstvo / Pod red. akad. V.I. Shumakova. M.: Medicina; Tula: Reproniks Ltd, 1995. 392 s.

10. Meyer SR, Modry DL, Bainey K et al. Declining need for permanent pacemaker insertion with the bicaval technique of orthotopic heart transplantation. Can. J. Cardiol. 2005; 21: 159–163.

11. Schnoor M, Schäfer T, Lühmann D, Sievers HH. Bicaval versus standard technique in orthotopic heart transplantation: a systematic review and meta-analysis. J. Thorac. Cardiovasc. Surg. 2007; 134: 1322–1331.

12. Cleveland JC, Naftel DC, Reece TB et al. Survival after biventricular assist device implantation: An analysis of the interagency registry for mechanically assisted circulatory support database. J. Heart Lung Transplant. 2011; 30: 862–869.

13. McKenna RM, Takemoto SK, Terasaki PI. Anti-HLA antibodies after solid organ transplantation. Transplantation. 2000; 69 (3): 319–326.

14. Шумаков ВИ, Хубутия МШ, Шевченко ОП. Отторжение трансплантированного сердца. М.: Реафарм, 2005. 240 с. Shumakov VI, Hubutiya MSh, Shevchenko OP. Ottorzhenie transplantirovannogo serdca. M.: Reafarm, 2005. 240 s.

15. Готье СВ, Белецкая ЛВ и др. Инфекции в трансплантологии. М.–Тверь: Триада, 2010. 384 с. Got’e SV, Beleckaya LV i dr. Infekcii v transplantologii. M.–Tver’: Triada, 2010. 384 s.

16. Costanzo MR. The international society of heart and lung transplantation guidelines for the care of heart transplant recipients. The Journal of heart and lung transplantation. 2010; 29: 914–956.

17. Neurologic Complications in Organ Transplant Recipients. Wijdicks EFM, ed. Boston: Butterworth-Heinemann. 1999.

18. Скворцова ВИ, Губский ЛВ, Мельникова ЕА. Синдром задней обратимой энцефалопатии. Журнал неврологии и психиатрии им. Корсакова. 2010; 5: 104–109. Skvorcova VI, Gubskij LV, Mel’nikova EA. Sindrom zadnej obratimoj ehncefalopatii. Zhurnal nevrologii i psihiatrii im. Korsakova. 2010; 5: 104–109.

19. Bartynski WS. Posterior Reversible Encephalopathy Syndrome, Part 1: Fundamental Imaging and Clinical Features. American Journal of Neuroradiology. 2008; 29 (6): 1036– 1042.

20. Chin C, Naftel DC, Singh TP et al. Risk factors for recurrent rejection in pediatric heart transplantation: a multicenter experience. J. Heart Lung Transplant. 2004; 23 (2): 178–185.