Heterotopic Heart Transplantation: Technical Considerations

Heterotopic heart transplantation is seldom used but may be due a renaissance. In a left assist configuration, heterotopic heart transplantation could expand the pool of heart donors and also enable transplantation in groups of patients who are currently not eligible for a heart transplant. With the biologic left ventricular assist (bio-LVA) concept, much as with a left ventricular assist device, the graft supports only the left side of the heart. It may be used in potential recipients with significant pulmonary hypertension in the absence of native right heart failure, as well as for small donor hearts, high-risk donor hearts, and left ventricular assist device contraindications. We have used bio-LVA transplantation sparingly over the years but see more opportunity for use in this era of donor shortage and improved postoperative management. This article describes the history of heterotopic heart transplantation, indications for the operation, results in recent series, and the technical details of bio-LVA transplantation.