Lucas Barbieri

By Lucas Barbieri, Noedir Stolf, Mariane Manso and Wallace André Pedro da Silva

Cardiac transplantation (TxC) is considered the first therapeutic option in patients with congestive heart failure, refractory to clinical treatment and without the possibility of conventional surgical treatment. The pathophysiological status, as a consequence of severe cardiomyopathy, is represented by various degrees of systolic and diastolic dysfunction, reflecting low ejection volumes and high diastolic volumes and high filling diastolic pressures, respectively. Patients in this pathophysiological context also present, among other symptoms, neurohormonal alterations of the renin-angiotensin aldosterone system, decreased renal, visceral and splanchnic perfusion, and increased levels of catecholamines. Barnard et al., in 1967, performed the first orthotopic heart transplantation among humans with relative success, Zerbini (1969) being the first to perform it in Brazil. The presence of high rates of graft rejection and infection accounted for small survival and caused great disinterest and abandonment of the technique in the 70’s. However, the experience accumulated by the groups that maintained TxC as a treatment, mainly after the introduction of cyclosporin A, first in kidney transplantation in 1978, and in 1980 in TxC, reinvigorated this therapeutic option, allowing the true development and the application of this treatment worldwide.

Part of the book: Heart Transplantation