Heart-Lung Transplantation

  • Don HayesJr.Email author
  • Michael S. Mulvihill
  • David McGiffin


Combined heart-lung transplantation (HLTx) is a surgical treatment for highly specific patients with advanced cardiopulmonary failure. Although the rates of patients undergoing HLTx have decreased over time, a few select centers continue to offer the procedure. Current indications include Eisenmenger syndrome with an uncorrected intracardiac defect, uncorrectable congenital heart disease with atresia or diffuse severe hypoplasia of the pulmonary arteries, and coexistent severe cardiopulmonary disease with advanced heart or lung failure. This chapter will outline aspects of thoracic transplantation that are specific to HLTx.


Aortopulmonary collaterals Domino-donor transplant Eisenmenger syndrome Heart-lung bloc Heart-lung transplantation 


  1. 1.
    Chambers DC, Yusen RD, Cherikh WS, Goldfarb SB, Kucheryavaya AY, Khusch K, Levvey BJ, Lund LH, Meiser B, Rossano JW, Stehlik J. International Society for Heart and Lung Transplantation. The Registry of the International Society for Heart and Lung Transplantation: thirty-fourth adult lung and heart-lung transplantation report-2017; Focus theme: allograft ischemic time. J Heart Lung Transplant. 2017;36:1047–59.CrossRefGoogle Scholar
  2. 2.
    de Perrot M, Granton JT, McRae K, Pierre AF, Singer LG, Waddell TK, Keshavjee S. Outcome of patients with pulmonary arterial hypertension referred for lung transplantation: a 14-year single-center experience. J Thorac Cardiovasc Surg. 2012;143:910–8.CrossRefGoogle Scholar
  3. 3.
    Fadel E, Mercier O, Mussot S, Leroy-Ladurie F, Cerrina J, Chapelier A, Simonneau G, Dartevelle P. Long-term outcome of double-lung and heart-lung transplantation for pulmonary hypertension: a comparative retrospective study of 219 patients. Eur J Cardiothorac Surg. 2010;38:277–84.CrossRefGoogle Scholar
  4. 4.
    Carrel A. Johns Hopkins Hosp Bull. 1907;18:18–28.Google Scholar
  5. 5.
    Demikhov VP. Experimental transplantation of vital organs. New York City: Consultants Bureau Enterprises, Inc.; 1962. American Edition translated from the 1960 Russian Edition by Basil Haigh, M.A., M.B., B.Chir.Google Scholar
  6. 6.
    Webb WR, Howard HS. Cardio-pulmonary transplantation. Surg Forum. 1957;8:313–7.PubMedGoogle Scholar
  7. 7.
    Longmore DB, Cooper DK, Hall RW, Sekabunga J, Welch W. Transplantation of the heart and both lungs. II. Experimental cardiopulmonary transplantation. Thorax. 1969;24:391–8.CrossRefGoogle Scholar
  8. 8.
    Grinnan GL, Graham WH, Childs JW, Lower RR. Cardiopulmonary homotransplantation. J Thorac Cardiovasc Surg. 1970;60:609–15.CrossRefGoogle Scholar
  9. 9.
    Nakae S, Webb WR, Theodorides T, Sugg WL. Respiratory function following cardiopulmonary denervation in dog, cat, and monkey. Surg Gynecol Obstet. 1967;125:1285–92.PubMedGoogle Scholar
  10. 10.
    Cooley DA, Bloodwell RD, Hallman GL, Nora JJ, Harrison GM, Leachman RD. Organ transplantation for advanced cardiopulmonary disease. Ann Thorac Surg. 1969;8:30–46.CrossRefGoogle Scholar
  11. 11.
    Wildevuur CR, Benfield JR. A review of 23 human lung transplantations by 20 surgeons. Ann Thorac Surg. 1970;9:489–515.CrossRefGoogle Scholar
  12. 12.
    Losman JG, Campbell CD, Replogle RL, Barnard CN. Joint transplantation of the heart and lungs. Past experience and present potentials. J Cardiovasc Surg (Torino). 1982;23:440–52.Google Scholar
  13. 13.
    Reitz BA, Wallwork JL, Hunt SA, Pennock JL, Billingham ME, Oyer PE, Stinson EB, Shumway NE. Heart-lung transplantation: successful therapy for patients with pulmonary vascular disease. N Engl J Med. 1982;306:557–64.CrossRefGoogle Scholar
  14. 14.
    Kirklin JK, Young JB, McGiffin DC. Heart transplantation. Philadelphia, PA: Churchill Livingstone; 2002.Google Scholar
  15. 15.
    Hopkins WE. The remarkable right ventricle of patients with Eisenmenger syndrome. Coron Artery Dis. 2005;16:19–25.CrossRefGoogle Scholar
  16. 16.
    Niwa K, Perloff JK, Kaplan S, Child JS, Miner PD. Eisenmenger syndrome in adults: ventricular septal defect, truncus arteriosus, univentricular heart. J Am Coll Cardiol. 1999;34:223–32.CrossRefGoogle Scholar
  17. 17.
    Saha A, Balakrishnan KG, Jaiswal PK, Venkitachalam CG, Tharakan J, Titus T, et al. Prognosis for patients with Eisenmenger syndrome of various aetiology. Int J Cardiol. 1994;45:199–207.CrossRefGoogle Scholar
  18. 18.
    Hopkins WE, Ochoa LL, Richardson GW, Trulock EP. Comparison of the hemodynamics and survival of adults with severe primary pulmonary hypertension or Eisenmenger syndrome. J Heart Lung Transplant. 1996;15:100–5.PubMedGoogle Scholar
  19. 19.
    D’Alonzo GE, Barst RJ, Ayres SM, Bergofsky EH, Brundage BH, Detre KM, et al. Survival in patients with primary pulmonary hypertension. Results from a national prospective registry. Ann Intern Med. 1991;115:343–9.CrossRefGoogle Scholar
  20. 20.
    Fuster V, Steele PM, Edwards WD, Gersh BJ, McGoon MD, Frye RL. Primary pulmonary hypertension: natural history and the importance of thrombosis. Circulation. 1984;70:580–7.CrossRefGoogle Scholar
  21. 21.
    Riedel M, Stanek V, Widimsky J, Prerovsky I. Long-term follow-up of patients with pulmonary thromboembolism. Late prognosis and evolution of hemodynamic and respiratory data. Chest. 1982;81:151–8.CrossRefGoogle Scholar
  22. 22.
    Robalino BD, Moodie DS. Association between primary pulmonary hypertension and portal hypertension: analysis of its pathophysiology and clinical, laboratory and hemodynamic manifestations. J Am Coll Cardiol. 1991;17:492–8.CrossRefGoogle Scholar
  23. 23.
    Weill D, Benden C, Corris PA, Dark JH, Davis RD, Keshavjee S, Lederer DJ, Mulligan MJ, Patterson GA, Singer LG, Snell GI, Verleden GM, Zamora MR, Glanville AR. A consensus document for the selection of lung transplant candidates: 2014--an update from the Pulmonary Transplantation Council of the International Society for Heart and Lung Transplantation. J Heart Lung Transplant. 2015;34:1–15.CrossRefGoogle Scholar
  24. 24.
    Lick SD, Copeland JG, Rosado LJ, Arabia FA, Sethi GK. Simplified technique of heart-lung transplantation. Ann Thorac Surg. 1995;59:1592–3.CrossRefGoogle Scholar
  25. 25.
    Pinderski LJ, Kirklin JK, McGiffin D, Brown R, Naftel DC, Young KR Jr, Smith K, Bourge RC, Tallaj JA, Rayburn BK, Benza R, Zorn G, Leon K, Wille K, Deierhoi M, George JF. Multi-organ transplantation: is there a protective effect against acute and chronic rejection? J Heart Lung Transplant. 2005;24:1828–33.CrossRefGoogle Scholar
  26. 26.
    Date H, Trulock EP, Arcidi JM, Sundaresan S, Cooper JD, Patterson GA. Improved airway healing after lung transplantation. An analysis of 348 bronchial anastomoses. J Thorac Cardiovasc Surg. 1995;110:1424–33.CrossRefGoogle Scholar
  27. 27.
    Griffith BP, Magee MJ, Gonzalez IF, Houel R, Armitage JM, Hardesty RL, Hattler BG, Ferson PF, Landreneau RJ, Keenan RJ. Anastomotic pitfalls in lung transplantation. J Thorac Cardiovasc Surg. 1994;107:743–54.CrossRefGoogle Scholar
  28. 28.
    Schafers HJ, Haydock DA, Cooper JD. The prevalence and management of bronchial anastomotic complications in lung transplantation. J Thorac Cardiovasc Surg. 1991;101:1044–52.CrossRefGoogle Scholar
  29. 29.
    Shumway SJ, Hertz MI, Maynard R, Kshettry VR, Bolman RM III. Airway complications after lung and heart-lung transplantation. Transplant Proc. 1993;25:1165–6.PubMedGoogle Scholar
  30. 30.
    Tamm M, Wallwork J, Higenbottam T. Heart-lung transplantation: results. In: Patterson GA, Couraud L, editors. Lung transplantation, vol. 3. Amsterdam: Elsevier Science; 1995. p. 399–423.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Don HayesJr.
    • 1
    Email author
  • Michael S. Mulvihill
    • 2
  • David McGiffin
    • 3
  1. 1.Department of Pediatrics, Nationwide Children’s HospitalThe Ohio State University College of MedicineColumbusUSA
  2. 2.Department of SurgeryDuke University School of MedicineDurhamUSA
  3. 3.Department of Cardiothoracic Surgery, The Alfred HospitalMonash UniversityMelbourneAustralia

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