a. Mariusz Kuśmierczyk is a cardiac surgeon and transplant specialist, and since 2021 he has been the Head of the Department of Cardiac Surgery at the Central Clinical Hospital of the University Medical Center of Warsaw Medical University. He is the president of the National Council of Agriculture.
Under what conditions is a heart transplant necessary in young people?
There are two groups of these patients. The first are patients who are “transplanted” practically for the same reasons as adult patients, that is, cardiomyopathy: dilated cardiomyopathy, hypertrophic cardiomyopathy, and restrictive cardiomyopathy. These are cases where the heart works properly for a while but becomes ineffective over time. The second group of patients, which must be clearly stated, has not yet been “taken care of” in our country, and in a moment there will be many such patients – these are patients with congenital defects, especially patients with one disease – the heart chamber , often after several previous operations.
Poland is the second country, after the United States, where most heart surgeries are performed in a single chamber. Since there is no miscarriage, many children are born with heart failure, and we have to perform life-saving operations (so-called Norwood surgeries).
After this surgery, these children are able to function completely normally for some time: study, study, work, but at some point their heart fails and they need another operation. The right ventricle, which becomes the systemic ventricle, has a different structure from the left ventricle, and after some time it cannot cope with it – there is no single-chamber heartbeat and the arterial pressure in the venous system increases. And this, in turn, leads to negative congestion of the organs, especially the liver. The result is fibrosis and cirrhosis of the liver of this organ, which can lead to the development of primary liver cancer.
These patients have to be treated somehow or else they will die, and this is a very complex multidisciplinary treatment. In such patients, it is not enough to perform a heart transplant only, and often a liver transplant is also necessary. Even if such a patient had liver cancer and still had a functional one-chamber heart, only a liver transplant would not make sense. Both of these organs need a transplant. And we have facilities for these transplants, and we’re just preparing to launch a concurrent heart and liver transplant program.
We’re after our first two successful heart transplants in sixteen-year-olds, we have a great team, enthusiasm, and people have seen that you can do things you fear nothing.
What about infections – are they said to sometimes end up in implants?
When it comes to myocarditis, the pandemic has recently allowed us some of that kind of disease, because some young people after COVID-19 have heart failure and have to have some kind of mechanical support for circulation or a new heart transplant. No one knows what COVID will leave in a few years, but we believe heart transplants may be necessary in the future for people with long-term complications of this disease.
In contrast, post-influenza and other viral myocarditis in times of severe failure can be treated by implanting artificial ventricles that support circulation for a period of time to give the heart time to regenerate. When this happens, usually after two or three weeks, the efficiency begins to improve, the contraction force reaches at least half that of a healthy person, we can “implant” this device, and the person gradually returns to normal functions. Although there is an incurable myocarditis, as a result, a transplant is necessary.
After a heart transplant, the patient returns to a relatively normal life, but with some limitations. What should he reckon with?
First of all, he has to accept the fact that he will have to go to the hospital from time to time for a thorough evaluation of transplant rejection, and so far the only way to verify this is a myocardial biopsy. He must also take into account the fact that he will develop angiopathy, that is, a disease of the blood vessels of the transplanted myocardium – in other words, coronary artery disease. This is a dangerous situation because it usually affects small blood vessels, and a reddish transplanted heart does not hurt – unlike a patient with an unplanned heart who feels pain in such a situation. So this should be checked in transplant patients.
Of course, lifelong immunosuppressive therapy and regular medical examinations are essential. But it must also be emphasized very clearly that these are sick people who do everything like healthy people. My first patient in 15 years was riding a bicycle 70 km a day and nothing happened to him. There is no better treatment than transplantation in severe heart failure so far.
How many people are affected by this during the year?
For several years, there were about 400-500 people on the planned list of heart transplants. Unfortunately, about 25 percent of them die without waiting for an organ. In our country, only people on the urgent list have a chance to have a heart transplant, because the demand is very high and there are few hearts.
How many hearts are transplanted annually?
Last year, we’ve performed 200 heart transplants nationwide. Unfortunately, it looks like we won’t be repeating that success this year. But it is worth noting that another area is also developing, namely mechanical circulatory support, which consists in the implantation of a pump in the patient so that he or she can live comfortably. Because when this pump replaces the left ventricle, the patient does not have to take cumbersome drug therapy and begins to function normally. Many patients get used to this pump, cable, battery and function in a completely normal way: they run a business, fly a plane, go on vacation. The only limitation is that you cannot take a shower in it. The result is that some of them not only need a transplant, they do not want it at all.
What is the biggest problem in organ transplantation in Poland nowadays?
Unfortunately, donation in Poland is still not at a very high level, so you have to talk a lot about it all the time and promote this type of treatment. Being on the other side, we can see what happens to these guys mostly on artificial support and we realize that if they don’t get a new heart, they’re going to die. Because this method has its limitations – if we do not find a heart for them within three months, the risk of complications increases sharply. They may be looking forward to their chance in life.
There will be more transplants at Warsaw Medical University. a. Jaseong
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