Unfortunately, we are not allowed to perform heart transplantation in patients who apply from overseas due to local legal issues in Turkey. However, we can help patients with cardiac problems who seek our healthcare by using our highly equipped facilities, such as cardio-assisted devices.
What is heart failure?
Heart failure occurs when the right, left or both of the ventricles (heart chambers) fail to function. Heart failure is a progressive disease and the power of the heart gradually decreases in time. Heart becomes dysfunctional to pump the required volume of blood by the body. Tissues and cells have difficulty in getting oxygen and nutrients.
Heart failure may occur at any age depending on the underlying cause. However, it occurs in 2.5% of people older than 45 years old and in 10% of those older than 65 years old. The end-stage heart failure causes death of more than half of patients within 1 year of diagnosis.
What are diseases causing heart failure?
- Coronary Artery Disease: The most common heart disease. Coronary arteries supplying the heart are narrowed and/or obstructed thus the myocardium is unable to get the required oxygen and nutrients and injured even dies (infarction), resulting in decreased power to contract.
- Complex Heart Valve Disease: Congenital or acquired aortic and mitral valve disorders increase the work load of the heart, resulting in heart failure due to a dilated or stressed heart.
- Dilated Kardiomyopathy: The heart is dilated and enlarged leading to heart failure associated with inadequate contraction of myocardium due to structural defect of heart muscle.
- Myocarditis: A disease resulting from decrease power of heart contraction due to a viral infection. Dysfunction of heart contraction might totally disappear after viral infection is healed, or might become permanent, resulting in heart failure.
What is the treatment of heart failure?
- devices to rectify arrhythmia,
- corrective surgeries (coronary bypass,
- valve surgeries, etc.)
However, the most effective methods in the treatment of end-stage heart failure are the heart transplant and support devices for artificial heart (cardio-assisted devices).
What is a heart transplant?
A heart transplant is to replace the dysfunctional ill heart with a healthy heart. When a healthy individual dies who donated their organs (donor), their kidneys, liver, heart, etc. are prepared for transplant to patients (receiver) for who a decision to transplant an organ has been previously taken.
Who can undergo a heart transplant?
- Cardiac patients younger than 65 years old are candidates for a heart transplant, who are in end-stage (Stage-D) of heart failure with a life expectancy less than 1 year.
- The older patients (65 to 72 years old) are carefully evaluated for their physical characteristics rather than their chronological age and they will be included in the program if they are appropriate.
There two common causes for a heart transplant.
- The first one is the coronary artery disease. Such patients are impossible to cure by a coronary bypass surgery or balloon-stent procedure. Irreversible myocardial serious or major damage may occur caused by previous attack and/or attacks associated with blocked coronary arteries.
- The second one is congenital or acquired weakness related to bacteria, viruses, etc. of the heart which is called cardiomyopathy. This may require a heart transplant when the contraction power of myocardium is largely reduced.
- The other rare causes include rheumatic fever, hypertension, valve diseases resulted in myocardium damage, congenital heart abnormalities impossible to correct surgically, and cardiac tumors
- Patients with severe arrhythmia are also candidates for heart transplant.
To be included and voluntarily participate in a heart transplant program, patients and family members should be aware and sure that;
- All known treatment methods have been considered, applied, and tried for their heart disease,
- They will lose their life if they do not undergo a heart transplant,
- They will be able to have the will to adopt the changes in their life and some applications that will be necessary for a lifetime or sometime before, but particularly after the transplant.
- Patients will be evaluated by specialists in the heart transplant team for the above medical, psychological, and social characteristics to be included in the program.
What is an artificial heart support device?
An artificial heart support device is a state-of-the-art technology device that assumes pumping function of the heart in patients of end stage heart failure. Temporary artificial heart support systems are available used until heart failure is healed, or until a heart transplant as well as permanent artificial heart support systems used for a life time.
Who can use an artificial heart support devices?
Heart support devices are used in patients with end-stage heart failure developed instantly or in time for mainly four purposes.
- For bridging (short-term use) to avoid dysfunctions of other organs in patients developed instant heart failure and to keep the patient alive until a permanent heart support system is activated.
- For bridging to recovery to keep the patient alive when the disease shows severe progression, e.g. diseases that lead to sudden heart failure resulting in myocarditis (inflammation of myocardium by viruses, etc.) but are completely healed after a pharmacotherapy.
- For bridging to heart transplant in patients who are in the waiting list but with a progressed heart failure when waiting for a heart.
- For use of a life time to improve time and quality of life of patients who are unable to have a heart transplant for various reasons (advanced age, severe renal or liver disease, etc.).
How is surgery for artificial heart support devices performed? What happens after the surgery?
Artificial heart support devices are categorized in two groups:
- implantable, miniature,
Which one to implant will depend on the severity of heart failure and patient’s general condition.
Although the surgery for artificial heart support device varies by the type of device, it approximately takes 3 to 6 hours. The patients will awaken from anesthesia in an isolated room in the intensive care unit (ICU). By the time, patient is disconnected from ventilator (device help the patient to breathe).
The patients stay in ICU for 2-3 days after the surgery and then are transferred to the private room where they will stay with a family member.
The duration of hospital stay is 20-25 days. These patients need to take blood diluents and have periodic blood tests during the whole period they live with a device, and consult with their doctor for dose of the medicines.
Who can have a total artificial heart?
A total artificial heart is a device replaced with the ill heart and implanted in the body.
- The first and mostly used one is Syncardia Cardiowest total artificial heart to keep the patient alive temporarily, i.e. until heart is transplanted. It is the latest version of the artificial heart developed by Dr. Kolff and Dr. Jarvik around 50 year ago.
It has been used with a success rate higher than 90% in hundreds of patients. This is the most commonly used total artificial heart.
- The other one is the permanent intracorporeal electric motor AbioCor TAH.