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Physicians Update

 
Fall 2009

Heart Transplantation Program Celebrates 25-Year Milestone

11/09/2009

Heart TransplatationWhen UCLA’s heart transplantation program was established in 1984, the procedure was widely considered experimental, and patients generally had little hope for long-term survival. Through a number of key advances, many of which where innovated at UCLA, heart transplantation for both adults and children has not only emerged as a standard of care, but also prompted development of related cardiac therapies that have extended the lives of end-stage heart-failure patients far beyond what was possible just 25 years ago.

“We have watched patients come to us with one foot in the grave, and then literally walk out the door to lead fairly normal lives after heart transplantation,” remarks Jon Kobashigawa, M.D., medical director of the Adult Heart Transplant Program at UCLA. UCLA is one of the leading heart transplantation centers in the nation, with more than 1,800 heart transplants performed and survival rates that exceed those reported by the International Heart Transplant Registry. Some UCLA patients have survived more than 20 years post-transplant, according to Dr. Kobashigawa.

But donor hearts are limited, and certain patients may never become eligible to receive a heart transplant. UCLA has been instrumental in expanding care to these patients. In partnership with the Ahmanson-UCLA Cardiomyopathy/Heart Failure Program, directed by Gregg Fonarow, M.D., therapies for heart failure, including implantable cardioverter defibrillators (ICDs) and bi-ventricular pacemakers that restore normal heart beats in patients with life-threatening arrhythmias, have improved health status, quality of life and survival so dramatically during the past 20 years that some patients no longer need transplantation. Additionally, under the leadership of Hillel Laks, M.D., UCLA pioneered the nation’s first Alternative Heart Transplant Program, which transplanted older donor hearts and borderline-functioning hearts that surgeons operate on before transplanting into recipients who would otherwise have been denied transplantation. The procedures have changed the definition of “alternative” donors by producing survival rates comparable to those in transplants using “traditional” donors. More recently, UCLA has actively advanced the use of left ventricular assist devices (heart pumps), which are used to partially or completely replace the function of a failing heart.

“Because of our high patient volumes at UCLA, we have been able to establish many of the protocols for using artificial devices as a bridge-to-transplantation for patients with weak hearts who are awaiting transplants, we have been able to identify the best ways to support patients until their hearts recover following cardiac surgery, and we have demonstrated that artificial devices can be successfully used to support a heart that is failing because of severe episodes of rejection,” says Richard J. Shemin, M.D., chief of the UCLA Division of Cardiothoracic Surgery and co-director of the Mechanical Circulatory Support Program at UCLA. To date, more than 250 artificial devices have been implanted at UCLA.





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