Technique and Controversies of Heart-Lung Transplantation

Combined heart-lung transplantation is the treatment of choice for selected patients with concomitant end-stage heart failure and end-stage lung disease. To date, more than 4000 adult heart-lung transplants have been reported from centers all over the world. However, over the last decade, a slight decline in the number of operations performed has been reported. This has been mainly due to improvements in the early diagnosis and clinical management of patients with end-stage cardiac and respiratory disease, along with the increasing success of surgical and interventional techniques for the treatment of congenital heart disease. Moreover, the increasing experience of transplant centers has reduced the indications for combined heart and lung transplantation and has increased the indications for isolated heart or lung transplant. The most common indications for combined heart-lung transplantation are complex congenital heart diseases with Eisenmenger syndrome and idiopathic pulmonary arterial hypertension or end-stage pulmonary disease associated to refractory cardiac failure; in these contests, referral to specialized centers should be considered in case of clinical deterioration and advanced New York Heart Association functional class despite optimal medical therapy and surgical treatment. A longer waiting time for a suitable donor and a potentially increased waiting list mortality should always be taken into consideration when a patient can be eligible for combined heart-lung transplantation as the most appropriate therapeutic strategy.