Samuel Jacob

By Samuel Jacob, Anthony N. Pham and Si M. Pham

Organ transplantation has kindled the human imagination since the beginning of time. Prehistorically, transplantation appeared as mythological stories: from creatures with body parts from different species, the heart transplant between two Chinese soldiers by Pien Ch’iao, to the leg transplant by physician Saints Cosmas and Damian. By 19th century, the transplantation concept become possible by extensive contributions from scientists and clinicians whose works had taken generations. Although Alexis Carrel is known as the founding father of experimental organ transplantation, many legendary names had contributed to the experimental works of heart transplantation, including Guthrie, Mann, and Demikhov. The major contribution to experimental heart transplantation before the clinical era were made by a team lead by Richard Lower and Norman Shumway at Stanford University in the early 1960s. They played the vital role in developing experimental and clinical heart transplantation as it is known today. Using Shumway biatrial technique Christiaan Barnard started a new era of clinical heart transplantation, by performing the first in man human-to-human heart transplantation in 1967. The techniques of heart transplant have evolved since the first heart transplant. This chapter will summarize the techniques that have been used in clinical heart transplantation.

Part of the book: Heart Transplantation

By Samuel Jacob, Pankaj Garg, Games Gramm and Saqib Masroor

Ischemic cardiomyopathy accounts for approximately two-thirds of all Heart Failure (HF) cases. Recent studies indicates that revascularization provides superior outcomes compared with optimal medical therapy (OMT) alone. Current European and American guidelines recommend an invasive approach in patients with reduced left ventricular ejection fraction (LVEF) less than 35% and with multivessel disease (MVD). Randomized controlled trials in these patients have proven that long-term survival is greater following coronary artery bypass grafting (CABG) than with OMT alone. Patients with ischemic cardiomyopathy and coronary artery disease that is amenable to surgical revascularization should undergo combination of surgical revascularization and medical therapy rather than medical therapy alone. In some cases, combined CABG with other surgeries are vital salvage procedures, such as atrial fibrillation, mitral valve, tricuspid valve, and LV remodeling. Based on small but, nontrivial, early mortality risk associated with CABG surgery as well as other post-CABG morbidities, patients may also reasonably choose medical therapy as initial treatment option. Revascularization remains an important treatment option for patients with ongoing anginal symptoms despite optimal medical therapy. In this chapter, we will highlight the role of CABG in heart failure treatment and when to use it as a salvage surgery before referring the patient for heart transplantation.

Part of the book: Coronary Artery Bypass Grafting

By Pankaj Garg, John H. Yazji, Emad Alamouti-Fard, Ishaq Wadiwala, Mohammad Alomari, Md Walid Akram Hussain, Mohamed Samir Hassan Elawady, Saqib Masroor and Samuel Jacob

In the United States, ~100,000 patients are hospitalized annually for cardiogenic shock with 27–51% mortality. Similarly, ~356,000 patients develop out-of-hospital cardiac arrests (OHCA) annually with 90% mortality. In the last few decades, several acute mechanical circulatory support (AMCS) devices have been developed to provide hemodynamic support and to improve outcomes in patients with cardiogenic shock and cardiac arrest. Among all the devices, venoarterial extracorporeal membrane oxygenation (VA-ECMO) is the only AMCS device that provides immediate and complete cardiopulmonary support. With an increase in clinical experience with VA-ECMO, use of VA-ECMO has expanded beyond post-cardiotomy cardiogenic shock. In the last two decades, there has also been a rapid growth in the observational and randomized data describing the clinical and logistical considerations with successful clinical outcomes in patients with cardiogenic shock and cardiac arrest. In this review, we discuss the fundamental concepts and hemodynamic aspects of VA-ECMO, its indications, contraindications, and the complications that are encountered in the setting of VA-ECMO in patients with cardiac arrest and cardiogenic shock of various etiologies.

Part of the book: Management of Shock