Author details

Early (<30 days) mortality ranges from 5% to 10% usually due to primary graft failure (35.3%), multiple organ failure (21.6%), and infection (14.3%); and 1-, 2-, 3-, 4-, 5-, 10-, and 15-year cumulative survival rates are 82, 78, 75, 72.5, 69.5, 52, and 34.4%, respectively [88]. A decline in 1-year overall survival after HTx from 85 to 76% in the EuroTransplant region has been observed, presumably because of increasing donor age and recipient comorbidity [90]. Early mortality and long-term survival rates in recipients assisted by ECMO are worse than those assisted by LVAD: early mortality is 35 versus 5%, and 1-, 2-, 3-, 4-, and 5-year survival rates are 60 versus 89%, 54 versus 86%, 51.5 versus 82%, 51.5 versus 81%, and 51.5 versus 76%, respectively [88]. The one-year survival after HTx is similar in patients with LVAD (89%), but complicated postimplant recipients have worse, 3-year survival than noncomplicated postimplant recipients (78 versus 85%) [89]. Long-term survival is dependent on several factors, but the availability of the donor hearts from younger male donors with shortest ischemic times is identified as the most significant factor improving long-term survival [91]. The median survival is at least 13.5 years for patients who survive the first year. Survival is lower in patients with valvular cardiomyopathy, congenital heart disease, or following retransplantation, and for those requiring pretransplant MCS. Additionally, patients who are sicker prior to transplant have worse survival outcomes [92]. Cardiac allograft vasculopathy is among the primary causes of death after the first year of HTx, and it is the most important limiting factor in long-term survival, along with neoplasms, with an incidence of 8% in the first year, 30% in 5 years,

Heart transplantation surgery is not a complex procedure, and surgical implantation techniques are the easiest part of HTx. The main problem with HTx is cold ischemic time to donor heart transportation, which should be <4 hours without continuous coronary perfusion or >4 hours with coronary perfusion via special equipment. The ideal cold ischemic time is shorter than 2 hours. Second problem is immunosuppression to prevent organ rejection, which is the main risk factor for graft failure preoperatively and early postoperatively (<1 year), and thereafter cardiac allograft vasculopathy is the major problem after the first posttransplant year. Third problem is increased PVR and it should be managed aggressively, because the unprepared donor RV may be unable to overcome this increased afterload. The standard technique is orthotopic HTx. The great arteries are transected at the sinotubular junctions, whereas the LA is insiced along the atrioventricular groove, leaving left atrial cuff for anastomosis. For biatrial technique, the RA is prepared with the same manner; however, for bicaval technique, both vena cavae are transected at their right atrial junctions. Bicaval anastomosis is a more common approach for implantation of the donor heart rather than biatrial technique [94]. The advantages of bicaval technique are reducing the right atrial size, preserving atrial conduction pathways, decreasing the risk of tricuspid regurgitation, and avoiding permanent pacemaker need [95]. Annuloaortic ectasia with the ascending aorta aneurysm could be managed by the replacement of the recipient ascending

and 50% in 10 years [93].

448 Cardiomyopathies - Types and Treatments

aorta during HTx [96].

Kaan Kırali1,2\*, Özge Altaş Yerlikhan<sup>1</sup> and Hakan Hançer<sup>1</sup>

\*Address all correspondence to: imkbkirali@yahoo.com

1 Department of Cardiac Transplantation and Ventricular Assist Device, Kartal Koşuyolu YIEA Hospital, Istanbul, Turkey

2 Department of Cardiovascular Surgery, Faculty of Medicine, Sakarya University, Sakarya, Turkey

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