European Journal of Cardio-Thoracic Surgery, Vol 7, 5-7, Copyright © 1993 by European Association for Cardio-thoracic Surgery
The development of heart and heart-lung transplantation at Stanford. Honored guest's lecture
N Shumway
Transplantation of the heart is now accepted and perhaps even routine
therapy for patients near death from heart disease. Better, more specific,
less toxic molecules are under investigation for the control of rejection.
The Holy Grail of tolerance is not beyond the realm of possibility. The
mini-chimera concept almost certainly raises the specter of potentially
successful xenografts. If not in this decade, certainly in this generation.
Transplantation of the heart and both lungs constituted the first
successful lung transplant of any kind. The ultimate division of
indications for single lung, sequential bilateral lung, or heart-lung
transplantation will be settled only by the accumulation of more clinical
data. With respect to pulmonary transplantation, a few technical points
have become clear. First, the double lung transplant with a tracheal
anastomosis has been abandoned owing to the complications of tracheal
stenosis and tracheal dehiscence. Second, there is no need to wrap the
bronchial anastomosis with omentum; there is no need to "telescope" the
donor bronchus. Finally, simple, continuous polypropylene suture technique
should be used for any tracheal (heart-lung transplantation) or bronchial
anastomosis.
