Heart-lung transplant, also called a heart lung block is the surgical removal of the heart and lungs at the same time and the patient is given new, healthy organs in their place. Also known as cardiopulmonary transplantation, or a heart-lung block, patients who need this procedure have end-stage heart and lung disease. While use of the heart-lung transplant is less than what it was even a few years ago, it continues to be a viable alternative for specific patient populations.
For many years, the medical world struggled to transplant the heart and lungs together, but after the development of a variety of newer anti-rejection medications and additional approaches to detect a potential rejection, more patients were able to undergo the process with positive outcomes.
Cardiopulmonary failure (failure of the heart and lungs to function as they should) has a variety of causes including congenital heart disease, primary pulmonary hypertension with irreversible right heart failure, sarcoidosis involving only the heart and lungs, or congenital cardiac anomalies with pulmonary hypertension.
A heart-lung block may also be used in patients with cystic fibrosis or end-stage bronchiectasis if they have compromised heart function as well.
To be considered for a heart-lung transplant, there are many factors that must be considered. For other types of transplants, the patient’s chronological age is important, however with this procedure physicians will look more closely at the physical state of the patient.
There is no lower age limit as long as the patient has sufficient room in the chest to accommodate the organs, and while some doctors say that upper limits stop at age 60, many medical centers will evaluate patients individually and may transplant older patients.
The most significant challenge with this procedure is finding suitable organ to transplant. All donated organs come from a patient who is brain-dead and has a healthy heart and lungs.
Because these patients are kept on a ventilator until organs are harvested, delicate lung tissue may deteriorate from conditions like pulmonary edema, atelectasis, fat embolism or infection. Lung tissue must also be transplanted relatively quickly—within 4 to 6 hours—making distance and transport of the organs difficult.
To receive a new heart-lung block, the patient is placed in cardiopulmonary bypass and the old organs are removed, using caution to ensure that the phrenic nerves are not damaged and that the blood supply to the bronchial arteries is not damaged to reduce the risk of post-operative bleeding.
The donor heart and lungs are then inserted, and the trachea is sewn into place first. The right atrium is attached next, followed by the aorta. Once the organs are in place, heart-lung bypass stops and blood flow is restored to the heart and lungs. The physician may have to shock the heart to initiate a rhythm, or the heart may start on its own. Once the organs are monitored for any bleeding, the chest will be closed and the patient will be sent to the intensive care unit.