Matthias Peltz, M.D. Answers Questions On: Heart Transplants

Heart disease remains the No. 1 killer of patients nationwide. Part of it is because, as a society, we have not done a good job of modifying our risk factors. There has been a decrease in smoking, but the dietary component probably has not changed substantially.

Also, people are living longer these days. As you age, you tend to develop heart disease. So you will see more people with heart disease as a result.

Absolutely. Part of the transplantation evaluation includes a dietary consultation. And after transplantation, we want to make sure patients maintain a heart-healthy diet.

Candidate selection is a very important part of evaluation, and it’s also crucial for successful outcomes. There are many factors that go into it, and we use a multidisciplinary approach with a lot of consulting services to arrive at the decision.

All the patients we’ve evaluated obviously have end-stage heart disease, but we also have to ensure that other illnesses will not prevent them from getting a transplant.

If they formerly smoked, they must now be a non-smoker. They cannot have any recent recreational drug use, and they must have strong family and social support to get them through the process.

One of the big problems with heart transplantation is that there aren’t enough available organs. Heart transplants have to be done in the most expeditious manner, because the organ can’t tolerate being outside the body for very long.

I’m researching how to support the donor heart better during storage. I’m using machine perfusion preservation, where the heart is perfused with an oxygenated, cold preservation solution to determine how long we can keep it out of the body and to see if we can use hearts that we typically don’t take. That would include organs from longer distances, older donors, or those with a degree of reversible heart injury.

Currently, those organs are not even considered. But one of our goals is to see if we can recover those donors and increase the donor supply so that this therapy can be offered to more patients.

Ventricular assist devices, or implantable pumps, are a good option for patients with end-stage heart disease who cannot get on the transplant list or patients who are too ill to receive a transplant on time due to the severity of their heart disease.

For end-stage heart disease, heart transplantation is probably the gold standard. But we now have more ventricular assist devices, which are continuously getting smaller.

In the foreseeable future, patients will have more options, from transplants to the various types of devices we offer.

With valvular surgery, we’ve moved toward less-invasive approaches, and those advances are ongoing. On the surgical end for severe coronary artery disease, bypass grafting is still the gold-standard therapy. We have improved how we take care of those patients, and this has resulted in even better outcomes of bypass surgery.