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Heart Needs Bypass Before Transplant : Medicine: UCLA doctors perform uncommon procedure, unclogging arteries of donated organ before surgery on recipient.

March 27, 1992|ROBERT STEINBROOK | TIMES MEDICAL WRITER

In an unusual transplant case, surgeons at UCLA Medical Center performed quadruple bypass surgery on a donated heart before implanting the organ into a 68-year-old man who was dying of heart disease.

The transplant is considered uncommon because surgeons usually accept only hearts that are in near-perfect condition and refuse to use hearts that have arteries clogged with fatty deposits. In addition, a common cause of death years after a heart transplant is blockage of the arteries, caused by the body's attempts to reject the foreign organ.

The surgery was performed Tuesday on James L. Taylor of Artesia. Taylor, a retired engineer with a history of heart attacks and severely weakened heart muscle, was reported in fair condition Thursday. The heart donor was a 53-year-old woman who died Monday.

In performing the bypass surgery, surgeons took veins from Taylor's leg and placed them around the blockages in four heart arteries.

The surgery has "gone very well," said Nellie Taylor, the patient's wife. "He is looking good. He needed the heart desperately."

"The heart has worked beautifully," said Dr. Hillel Laks, who performed the surgery. Laks, chief of cardiothoracic surgery at UCLA, said he recommended the surgery because "there was a very serious possibility that (the patient) would not survive until the next heart became available.

"He could not peel an orange without getting short of breath." The patient and his family, Laks said, "were very keen to go ahead and not take any further chances because he was deteriorating so quickly."

Laks could have implanted a mechanical left-ventricular assist device to tide the patient over for weeks or months until another organ was found, as is done in some heart transplant cases. But Laks said this option, which would have kept the patient tethered to a machine, was rejected after weighing the case.

Statistics are not available, but Laks said the combination of bypass surgery and heart transplant has been performed only once before--in Canada in 1988. That involved the bypass of one heart artery.

Two heart transplant surgeons not connected with the case expressed surprise when informed of the decision.

"This is very controversial," said Dr. Carlos Blanche, co-director of the heart transplant program at Cedars-Sinai Medical Center. "A heart with coronary artery disease that needs bypass surgery is much less than an ideal donor heart."

Dr. Norman Shumway, professor of cardiovascular surgery at Stanford University, said the operation was "very unusual." Shumway, one of the world leaders in the field, added: "If the recipient was so sick that this was the only chance for the individual, such an approach was probably warranted."

The surgery is another manifestation of the long waits for transplants and the shortage of donor organs.

More than 2,200 patients are on a national waiting list for heart transplants, according to statistics compiled by the United Network for Organ Sharing in Richmond, Va. Six hundred-fifty people died while waiting for heart transplants in 1990, the most recent year for which statistics are available. About 2,000 heart transplants are performed in the United States each year.

Laks said a heart-transplant recipient in Southern California usually has to wait six months for a suitable organ to become available. Laks said that if surgeons were more open to using less than "optimal hearts," fewer patients might die while waiting.

The case also reflects how surgeons are extending the boundaries of heart transplantation to older individuals. Until recently, it was very unusual to offer heart transplants to patients older than 55 because of the increased risk that such patients do not have the same chances to survive surgery as younger ones.

The donor heart became available after the 53-year-old woman was pronounced brain dead at another hospital. Physicians at that hospital evaluated the condition of the organ as is routine in such cases, Laks said. The woman had no history of heart disease and her heart contracted normally. But a coronary arteriogram revealed blockages in the arteries that supply blood to the heart.

The heart was removed from the woman, preserved in a cold solution and transferred to UCLA for the transplant.

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