La Paz Hospital successfully transplants two hearts in asystole for the first time in Spain

Hospital La Paz has performed two heart transplants for the first time in Spain -one to an adult and the other to a 14-year-old girl- in controlled asystole, a technique that makes it possible to maintain donor organs through a treatment that restores blood flow and prevents said organ from being lost.

As reported by the Community of Madrid in a statement, both recipients of these hearts suffered from complex congenital heart disease and had undergone multiple previous operations.

The first of the transplants was performed in September 2021, and the recipient of the organ was a 36-year-old man with a highly complex congenital heart disease: univentricular circulation corrected with Fontan surgery and advanced liver involvement, and it became his fifth major heart surgery.

Heart transplants on Fontan failure are technically the most complex and the ones with the highest hospital mortality. Nevertheless, the patient evolved favorably after surgery and, after three months of hospital admission, he was discharged. Currently he continues to attend routine check-ups on an outpatient basis and leads a life without physical limitations.

The second transplant It was received last November by a 14-year-old girl who since she was a few months old He had to undergo a complex surgery – which was followed by two more during his childhood – to treat the serious congenital heart disease he suffered from.

In his case, the transplant was his fourth major heart operation and, After spending a month in hospital, today she leads a normal life and has joined the school.

Heart transplantation in patients with congenital heart disease is the treatment of choice when these people develop advanced heart failure that is not subsidiary to medical treatment or remedial techniques. However, due to the significant difficulties associated with the process in this population, this technique is rarely performed.

Thanks to the surgical improvements experienced in recent decades, the number of patients with congenital heart disease who reach adulthood and ends up developing heart failure in its evolution has increased significantly and an even greater increase is estimated in the coming years.

To increase the number of potential heart donors Cardiac donation emerged in controlled asystole (DAC), a technique that allows the recovery of organs through reperfusion, a medical treatment to restore blood flow, in this case of an organ, to allow the operation.

For this, an Extracorporeal Membrane Oxygenation (ECMO) system is used for the person who died in a hospital environment after a limitation of therapeutic effort. This technique makes it possible to incorporate donation into end-of-life care in some patients.

Controlled asystole donation has been shown to have similar results to classical donation in brain death and its use is increasing widely in other surrounding countries. In Spain, the number of interventions performed with this technique is currently very low, and its use in patients with congenital heart disease has not been described to date.