Author + information
- Joseph G. Rogers, MD∗ ( and )
- JoAnn Lindenfeld, MD
- ↵∗Address for correspondence:
Dr. Joseph G. Rogers, Division of Cardiology, Duke University, Box 3034, Duke University Medical Center (DUMC), 2400 Pratt Street, Durham, North Carolina 27710.
Happy 50th Birthday, Cardiac Transplantation
Joseph Rogers, MD
Division of Cardiology, Duke University Medical Center, Duke University, Durham, North Carolina
On December 3, 2017, the world will celebrate the 50th anniversary of the first successful heart transplant, that was performed by Christiaan Barnard in Cape Town, South Africa. Transplantation of the human heart represented a monumental achievement at that time—biomedical research, surgical acumen, and innovation. However, the intrigue transcended the technical aspects of transplantation. Many were drawn to the romanticized heart: the figurative representation where love, emotions, and feelings reside. The confluence of science and romance captured the world’s attention in early December 1967, and forever altered the outlook for patients with advanced heart failure.
The race to perform the first human heart transplant in the United States was bicoastal, with teams at Stanford led by Norman Shumway and at the Medical College of Virginia led by Richard Lauer perfecting the surgical technique in the laboratory and defining the fundamentals of immunosuppression. Cardiac surgeons from across the globe came to the United States to learn from Shumway and Lauer, including Christiaan Barnard, a young, talented, and charismatic South African. While the United States teams raced to perform the first transplant, Barnard and his team were caring for Louis Washkansky, who was dying of end-stage ischemic cardiomyopathy. By most accounts, Washkansky was quite ill with progressive end-organ impairment and intractable symptoms. Southey tubes had been inserted in to the subcutaneous tissues of his legs to drain the edema. Simultaneously, Denise Darvall experienced a mortal head injury after being struck by an automobile. After identifying that Darvall would not recover from her injuries, the Cape Town team prepared for and performed the first successful transplant. Washkansky survived for 18 days before dying of pneumonia. Although there are many poignant photographs and recollections of those monumental days, perhaps the most impactful is the picture of Barnard sitting on the edge of Washkansky’s hospital bed showing him the heart that had beat in his chest for 54 years.
Early outcomes with heart transplantation nearly doomed the field. Short-term survival was poor, and most centers that had prepared for transplantation abandoned their programs. It was not until the early 1980s, when cyclosporine became available and the results of transplantation improved, that programs reopened and the number of patients receiving transplants increased. The rapid growth in patient volume and the strong desire to understand the complexities of transplantation led to pivotal observations in the immune response to transplanted organs, novel immunosuppressive regimens, rejection monitoring, cardiac biopsy, infections in the immunocompromised host, and the effect of the denervated heart on functional capacity and symptoms.
As we reflect on the success of transplantation over the past 50 years, we celebrate the very best of medicine—scientists and clinicians who recognized a clinical problem and dedicated themselves to a solution through the rigors of fundamental and clinical investigation, industry who partnered to develop new drugs and devices that improved care, and governmental agencies that formed the foundation for equitable distribution of donor organs and a platform for data collection. Transplantation inspired us to develop a multidisciplinary, team-based approach to medical care in which physicians, surgeons, nurses, pharmacists, social workers, and rehabilitation specialists focused their expertise in a patient-centric manner.
At the forefront of our strategic partners, however, are the patients with advanced heart failure, organ donors, and their respective families. Transplantation is built on different principles than other areas of medicine. Altruism, trust, and care for the human spirit are part of the lexicon of transplantation that uniquely defines the relationship amongst our patients, their caregivers, those experiencing the recent loss of a family member, and the medical team.
Happy Birthday, heart transplantation. We wish for your next 50 years to be filled with all of the success, joy, and health that you have experienced in the past. May you continue to grow in impact and may the importance of your history never be forgotten. Most importantly, we wish that you never lose the care and compassion you have shown to families in their greatest time of need.
Happy 5th Birthday, JACC: Heart Failure
JoAnn Lindenfeld, MD
Advanced Heart Failure and Cardiac Transplant Program, Vanderbilt Heart and Vascular Institute, Nashville, Tennessee
This issue of JACC: Heart Failure celebrates the 50th anniversary of cardiac transplantation, but is also the final issue of the first 5 years of JACC: Heart Failure. This focus issue allows us to look back and determine if we are succeeding in our initial goals of developing a clinically relevant, high-quality journal that presents new high-quality research, provides state-of-the-art reviews of important clinical topics, and provides opinions about important controversies or insights into the future. We can see that we are moving toward all of those goals in this issue. In 2 important State-of-the-Art Papers reviewing “Current Outcomes and Contemporary Controversies” in cardiac transplantation (1) and “Evolving Areas in Heart Transplantation” (2), the authors review the state of the field and outline important areas for ongoing research. Subsequent papers begin to provide answers in a number of important areas outlined.
The shortage of suitable donor hearts is an ongoing problem addressed in 3 papers in this issue. Madan et al. (3) suggest that we may be able to expand the donor pool by the use of adolescent hearts in adults—a practice that is discouraged in many centers. Raeisi-Giglou et al. (4) outline how donor availability may be affected by the new donor allocation system. Tavazzi et al. (5) provide data that cardiac donor dysfunction may share common pathophysiological pathways with Takotsubo cardiomyopathy and point out that our understanding of donor dysfunction may benefit from ongoing insights into the pathophysiology of donor dysfunction, allowing the utilization of a greater number of donor hearts.
Kobayashi et al. (6) provide important insights into the use of echocardiographic longitudinal strain for the diagnosis of cardiac rejection. Improved methods of diagnosis rejection are clearly needed, and noninvasive methods are particularly important. Tremblay-Gravel et al. (7) demonstrate, using a historical analysis, that coronary graft vasculopathy can have a better prognosis in the current era and suggest potential reasons.
The use of implantable cardioverter-defibrillators in left ventricular device recipients and their effect on mortality using data from the INTERMACS (Interagency Registry for Mechanically Assisted Circulatory Support) registry offers important insights into a common clinical conundrum—do implantable cardioverter-defibrillators prolong life in these patients?
This focus issue will be of great interest to clinicians who care for patients with LVADs and those who have had a cardiac transplantation. It allows us to learn from the past, but to also look to the future with a clear outline of problems that need to be addressed and several papers that provide some answers.
- 2017 American College of Cardiology Foundation
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- Kobashigawa J.A.
- Weber B.N.,
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- Raeisi-Giglou P.,
- Rodriguez E.R.,
- Blackstone E.H.,
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- Hsich E.M.
- Tavazzi G.,
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- Via G.,
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- Kobayashi Y.,
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- Tremblay-Gravel M.,
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