Heart and Diabetes Center NRW - Clinic for Thoracic and Cardiovascular Surgery

Alternatives and bridges to organ transplantation

artificial heart

40 years after the first heart transplantation, this intervention is now a routine occurrence at the Heart and Diabetes Center NRW. Whereas, when transplantation surgery began, one of the greatest problems was how to overcome organ rejection, nowadays it is the lack of available donor organs. 412 hearts were transplanted in the year 2006 in Germany, 74 of them at our Center, but the requirement was twice as high. Because a suitable organ cannot always be found in time, and because some patients cannot be transplanted due to pre-existing diseases, viable alternatives to organ transplantation are constantly being sought.

Ventricular assist devices bridge the wait until transplantation

Many patients have to wait a long time for a heart transplantation because there are simply not enough donor hearts available. Most of these patients would not normally be able to survive the wait, due to their weak hearts. The solution is to get patients through the waiting period with the help of mechanical circulatory support systems (ventricular assist devices or VADs). This is known as bridging. The VAD technology amounts to artificial support of the heart and is incorporated in different blood pumps with different drive systems.

VAD systems assume the pumping action of the left and/or right side of the heart. The body is thus once again supplied with sufficient blood/oxygen, stabilizing the condition of severely sick patients. In some cases the pump is implanted underneath the abdominal wall, connected by a cable to a power supply and system controls outside the body. With some other systems the whole pump is located outside the body. Which system is chosen largely depends on the height and weight of the patient. Some systems enable patients to go home and wait for their transplantation in their familiar surroundings. This not only increases the patient’s quality of life at this difficult time; it also helps to keep the costs down.

Artificial hearts replace diseased hearts

An artificial heart (total artificial heart or TAH) replaces the human heart. At the Heart and Diabetes Center NRW, 100 patients have successfully received a TAH for bridging purposes to date, namely the CardioWest system developed by Robert Jarvik. It is driven by an external compressed air system, which poses restrictions on patient mobility. The CardioWest system can, however, be combined with the mobile Excor drive, developed in 2003 by members of the Department of Cardiotechnology at the Heart and Diabetes Center NRW in close cooperation with the Clinic for Thoracic and Cardiovascular Surgery and the company Berlin Heart. This drive is considerably smaller and more comfortable, enabling patients to return to their accustomed environments.

Conclusion:

The ever-growing waiting lists for heart transplantation and increasing numbers of patients with terminal cardiac deficiency have taught us that human beings are capable of surviving for long periods with VADs and artificial hearts, and that their quality of life is vastly improved in the meantime.

Systems like LionHeart™ and AbioCor have many advantages for patients. There is no wound in the abdominal wall, thus considerably reducing the risk of infection. The human body does not reject these pumps in the manner of foreign organs, meaning that patients do not require immunosuppressive medication. Coagulation must be restricted, however, so that no blood clots can form. Prof. Reiner Körfer, MD, Dr. h.c.: “Despite all their advantages, these technical systems are unlikely to render organ transplantation from person to person superfluous, especially in children, where these systems are of limited use. Nevertheless, we hope that the introduction of fully implantable artificial hearts will mean shorter waiting lists for heart transplantation and, in selected cases, even an alternative to transplantation. With these systems the overall situation for people with severe heart disease is undergoing general improvement.”

Over 1500 VAD systems have been successfully implanted by Prof. Reiner Körfer, MD, Dr. h.c. and his specialist team in Bad Oeynhausen since 1987, making our hospital global leader in the implementation of VADs and TAHs.