Currently, the IKEM Cardiology Centre utilises almost all therapeutic approaches available in the world in the treatment of chronic heart failure, including the heart transplantation programme. This programme is developed on a level comparable with leading transplantation centres in the world. Patients with chronic heart failure are examined in the outpatient setting and further steps are determined upon evaluation of their condition. Some patients benefit from implantation of a special cardiostimulation system able to stimulate both ventricles and synchronise their function (biventricular stimulator); other patients need to be protected against life-threatening arrhythmias by implantation of a device that can recognise any serious rhythm disorder and cancel it by a discharge (automatic implantable defibrillator). These devices are implanted in patients during hospitalisation. Detailed assessments needed to decide on surgical therapy are another reason for hospitalisation. In some cases, we consider surgical reconstruction of coronary arteries (aortocoronary bypass), replacement of impaired cardiac valves or surgical treatment of the left ventricle. However, most patients are treated using medications and are monitored in the outpatient setting.
Since 1984, the IKEM Cardiology Centre has performed more than 1,000 heart transplantations in patients with highly advanced heart failure.
The care of these patients has its specific features. The donated heart induces an immune response in the recipient organism, causing rejection of the transplanted organ. Therefore after the transplantation, every patient must use a combination of drugs for the rest of their life to prevent rejection of the transplanted organ – immunosuppressants. This immunosuppressive therapy must be managed by doctors – specialists with rich clinical experience. Rejection episodes of the transplanted heart – acute rejections – sometimes also occur with immunosuppressive therapy, especially early after the transplantation. In order to detect these conditions as soon as possible before they are manifested by a cardiac function disorder and in order to provide timely treatment, endomyocardial biopsy is done in patients after heart transplantation in regular intervals. This procedure is done at the catheterisation theatre and consists in the collection of very small samples of the heart muscle using a small pincer – the bioptome. The samples of the heart are examined on the same day and further therapy is adjusted according to the result.
In the first year from heart transplantation, most follow-up visits associated with endomyocardial biopsy are done during hospitalisation. Between control hospitalisations, patients undergo outpatient cardiology assessments. After the first year from transplantation the patients are monitored in the outpatient setting.