Relation between Norman and Heart transplantation

By dinakaran soundara paulraj group-18

Norman shumway• Norman Edward Shumway (February 9, 1923 – February 10, 2006

was a pioneer of heart surgery at Stanford University.

Early life• Shumway was born in Kalamazoo, Michigan. He attended the University of

Michigan for one year as an undergraduate until he was drafted by the Army in 1943, which sent him to John Tarleton Agricultural College in Stephenville, Texas for engineering training.

• He received his M.D. from Vanderbilt in 1949. • He did his residency at the University of Minnesota under Walt Lillehei

alongside future fellow transplantation pioneer Christian Barnard, and was awarded a surgical doctorate in 1956.

• In his later years Shumway was the first recipient of the Lifetime Achievement Award given by the International Society for Heart & Lung Transplantation. He also received the 1994 Lister Medal.

• Honorary degree, University of Pavia,1998.

He died of lung cancer in Palo Alto in 2006, on the day after his 83rd birthday.

Heart transplantation• Norman Shumway is widely regarded as the father of heart

transplantation although the world's first adult human heart transplant was performed by a South African cardiac surgeon, Christiaan Barnard utilizing the techniques developed and perfected by Norman Shumway and Richard Lower.

• Barnard performed the first transplant on Louis Washkansky on December 3, 1967 at the Groote Schuur Hospital in Cape Town South Africa.

• Adrian Kantrowitz performed the first pediatric heart transplant in the world on December 6, 1967 at Maimonides Hospital (now Maimonides Medical Center) in Brooklyn, New York barely three days after Christiaan Barnard.

• Norman Shumway performed the first adult heart transplant in the United States on January 6, 1968 at the Stanford University Hospital.

• In the 1970s he and his team refined the operation, tackling the problems of rejection and the necessity for potentially dangerous drugs to suppress the immune system. In particular he pioneered the use of cyclosporine, instead of traditional drugs, which made the operation safer.

• A heart transplant, or a cardiac transplant, is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease.

• As of 2008 the most common procedure was to take a working heart from a recently deceased organ donor (cadaveric allograft) and implant it into the patient.

• The patient's own heart is either removed (orthotopic procedure) or, less commonly, left in place to support the donor heart (heterotopic procedure); both were controversial solutions to an enduring human ailment.

• Post-operation survival periods averaged 15 years.Heart transplantation is not considered to be a cure for heart disease, but a life-saving treatment intended to improve the quality of life for recipients.

Stitching of the implant donor heart to patient

Need and procedure of transplant

epidemiology• Worldwide, about 3,500 heart transplants are performed annually. The vast

majority of these are performed in the United States (2,000-2,300 annually).• Cedars Sinai Medical Center in Los Angeles, California currently is the

largest heart transplant center in the world and has performed the most number of yearly heart transplants in the last four consecutive years performing 119 transplants in 2013 alone.

• Xenografts(research into the transplantation of non-human hearts into humans after 1993) from other species and man-made artificial hearts are two less successful alternatives to allografts.

NUMBER OF HEART TRANSPLANTS REPORTED BY YEAR

Pre-operative

• A typical heart transplantation begins when a suitable donor heart is identified. The heart comes from a recently deceased or brain dead donor, also called a beating heart cadaver.

• The patient is contacted by a nurse coordinator and instructed to come to the hospital for evaluation and pre-surgical medication.

• At the same time, the heart is removed from the donor and inspected by a team of surgeons to see if it is in suitable condition. Learning that a potential organ is unsuitable can induce distress in an already fragile patient, who usually requires emotional support before returning home.

The patient must also undergo emotional, psychological, and physical tests to verify mental health and ability to make good use of a new heart. The patient is also given immunosuppressant medication so that the patient's immune system does not reject the new heart.

Operative• Once the donor heart passes inspection, the patient is taken into the operating room

and given a general anaesthetic. • Either an orthotopic or a heterotopic procedure follows, depending on the conditions

of the patient and the donor heart.

Orthotopic procedure• The orthotopic procedure begins with a median sternotomy, opening the chest

and exposing the mediastinum. The pericardium is opened, the great vessels are dissected and the patient is attached to cardiopulmonary bypass.

• The donor's heart is injected with potassium chloride (KCl). Potassium chloride stops the heart beating before the heart is removed from the donor's body and packed in ice. Ice can usually keep the heart usable four to six hours depending on preservation and starting condition.

• The failing heart is removed by transecting the great vessels and a portion of the left atrium. The patient's pulmonary veins are not transected; rather a circular portion of the left atrium containing the pulmonary veins is left in place.

• The donor heart is trimmed to fit onto the patient's remaining left atrium and the great vessels are sutured in place. The new heart is restarted, the patient is weaned from cardiopulmonary bypass and the chest cavity is closed.

The orthotopic procedure was developed by Shumway and Lower at Stanford-Lane Hospital in San Francisco in 1958.

Heterotopic procedure• In the heterotopic procedure, the patient's own heart is not removed. The new heart

is positioned so that the chambers and blood vessels of both hearts can be connected to form what is effectively a 'double heart'.

• The procedure can give the patient's original heart a chance to recover, and if the donor's heart fails (e.g., through rejection), it can later be removed, leaving the patient's original heart.

• Heterotopic procedures are used only in cases where the donor heart is not strong enough to function by itself (because either the patient's body is considerably larger than the donor's, the donor's heart is itself weak, or the patient suffers from pulmonary hypertension).

Post-operative• The patient is taken to the ICU to recover. When they wake up, they move to a

special recovery unit for rehabilitation. • The duration of in-hospital, post-transplant care depends on the patient's

general health, how well the heart is working, and the patient's ability to look after the new heart.

• After 1-2 weeeks the patientwill be release, the patient returns for regular check-ups and rehabilitation. They may also require emotional support. The frequency of hospital visits decreases as the patient adjusts to the transplant.

• The patient remains on immunosuppressant medication to avoid the possibility of rejection. Since the vagus nerve is severed during the operation, the new heart beats at around 100 beats per minute unless nerve regrowth occurs.

Complications

Post-operative complications include infection, sepsis, organ rejection, as well as the side-effects of the immunosuppressive medication.

Since the transplanted heart originates from another organism, the recipient's immune system typically attempts to reject it. The risk of rejection never fully goes away, and the patient will be on immunosuppressive drugs for the rest of his or her life, but these may cause unwanted side effects, such as increased likelihood of infections, like fevers, unusual pains, or any new feelings.

Recipients can get kidney disease from a heart transplant. Many recent advances in reducing complications due to tissue

rejection stem from mouse heart transplant procedures

Notable recipients• At the time of his death on August 10, 2009, Tony Huesman was the world's longest living

heart transplant recipient, having survived for 31 years. Huesman received a heart in 1978 at the age of 20 after viral pneumonia severely weakened his heart. Huesman died of cancer.[11] The operation was performed at Stanford University under heart transplant pioneer Dr. Norman Shumway.[12]

• Kelly Perkins climbs mountains around the world to promote positive awareness of organ donation. Perkins was the first recipient to climb the peaks of Mt. Fuji, Mt. Kilimanjaro, the Matterhorn, Mt. Whitney, and Cajon de Arenales in Argentina in 2007, 12 years after her surgery.[citation needed]

• Twenty-two years after Dwight Kroening's heart transplant, he was the first recipient to finish an Ironman competition.[13]

• Fiona Coote was the second Australian to receive a heart transplant in 1984 (at age 14) and the youngest Australian. In the 24 years after her transplant she became involved in publicity and charity work for the Red Cross, and promoted organ donation in Australia.[citation needed]

• Race car driver and manufacturer Carroll Shelby received a heart transplant in 1990.[14]

• Kenneth Claus, transplanted September 23, 1988, Shands Hospital, Gainesville, Florida was ranked by Rate My Professors as one of the top 25 professors for the U.S. in 2009 - 2010: he was 19th. He still teaches 3 semesters a year at Florida International University, Miami, Fl.

Artifical heart

• An artificial heart is a man-made device that is implanted into the body and replaces a person’s biological heart (Wikipedia).

• An artificial heart is representative of modern technology in medicine.

• An artificial heart is a medical instrument that is was created in the 1950’s.

• The estimated cost is $150,000 per implanted artificial heart, which can increase the U.S. medical bill by anywhere from $2.5 to $3 million (Jarvik & Callahan, 1986).

• The use of an artificial heart to replace heart transplants is controversial.

Jarvik 7

• Jarvik 7 was the first artificial heart.• The first patient received the heart in 1982 and consequently

died 112 days later from technical problems.• It took years to conquer, but the problems associated with the

original Jarvik 7 have been worked out in order for the heart to benefit others.

• It can support circulation and improve health in even extremely sick people (Jarvik & Callahan, 2007).

• Robert Jarvik created and experimented with the first artificial heart in the 1950’s.

• Jarvik received a patent for his work in 1963.• The first implantation of an artificial heart was done in April 4,

1969 at the Texas Heart Institute in Houston (Wikipedia, 2007).

Jarvik vs Norman • Using an artificial heart in medical procedures is a controversial

issue. However, the demand for real hearts is growing and the supply is not. Using an artificial heart may be beneficial to many because it can help save lives.

• There is always a higher demand for heart transplants compared to the number of hearts available. An artificial heart will lower the need for heart transplants.

NOW A DAYS • French biomedical firm Carmat said that it had begun the first

human trial of its prototype artificial heart, which aims at overcoming shortages of organs available for transplant.

• The Carmat product aims to provide a longer-term solution to bridge the wait for a donor heart and enable hospitalised patients to return home and maybe even resume work.

• The artificial heart, a self-contained unit implanted in the patient’s chest, uses soft “biomaterials” and an array of sensors to mimic the contractions of the heart.

• The patient had received his artificial heart on Dec. 18,2013 in a work first performed after the French government gave its green light to the operation in September.

• “Seventy-five days after the implant of the first Carmat artificial heart bioprosthesis in a 76-year-old man with a terminal heart disease, the patient died on March 2, 2014,” the Georges-Pompidou European Hospital said.

conclusion

• Nearly 100,000 people in Europe and the United States are in need of a heart transplant, according to Carmat.

• A U.S. rival to Carmat, an artificial heart called AbioCor, is authorised in the United States for patients with end-stage heart failure or life expectancy of less than 30 days, who are not eligible for a natural heart transplant and have no other viable treatment options.

• If we invent a artifical heart, we don’t want donor or we didn’t die for heart diseases.

• Another thing thing andtill we found artifical heart,we must aware the people to donate organs

References•  Reiner Körfer (interviewee) (2007). The Heart-Makers: The Future of

Transplant Medicine (documentary film). Germany: LOOKS film and television.

• Glick, Shav (31 January 1996). "Kidney Transplant a Success for Shelby". Los Angeles Times.

• "William G. McGowan: Monopoly Buster". Entrepreneur. October 10, 2008. Retrieved September 7, 2012.

• Sandeep Jauhar, M.D., Ph.D.: The Artificial Heart. New England Journal of Medicine (2004): 542–544.

• J. Wei, K. K. Cheng, D. Y. Tung, C. Y. Chang, W. M. Wan, Y. C. Chuang: Successful Use of Phoenix-7 Total Artificial Heart. Transplantation Proceedings, 1998, 30:3403-4.

• Berger, Eric. "New artificial heart 'a leap forward'". Houston Chronicle. Retrieved 23 March 2011.

• #A new pulsatile total artificial heart using a single centrifugal pump., K. Imachi, T. Chinzei, Y. Abe, K. Mabuchi, K. Imanishi, T. Yonezawa, A. Kouno, T. Ono, K. Atsumi, T. Isoyama, et al.. Institute of Medical Electronics, Faculty of Medicine, University of Tokyo, Japan.

• Mitka, Mike. "Midwest Trials of Heart-Assist Device." Journal of the American Medical Association 286.21 (2001): 2661.

• Bishay, R. The ‘ Mighty Mouse’ Model in Experimental Cardiac Transplantation. Hypothesis 2011, 9(1): e5.