/ Dr. Cormac Redehan
I graduated from University College Dublin in 1985 and was conferred with a Fellowship of the Faculty of Anaesthetists, Royal College of Surgeons in December 1989. In 1993, I completed a Clinical fellowship at the Toronto Hospital, Ontario, Canada before moving to the Cleveland Clinic, in Ohio, USA. There I spent over a year completing a cardiothoracic anaesthesia fellowship with a particular interest in Lung Transplantation.
I have worked back in Dublin since 1996 at both Cappagh National Orthopaedic Hospital and the Mater Misercordiae University Hospital. My clinic commitments extend to the preoperative assessment clinic and upper and lower limb surgery at Cappagh Hospital while at the Mater Hospital I have been able to continue my interests in airway anaesthesia, cardiothoracic anaesthesia and transplantation. I am involved in teaching at the cardiopulmonary resuscitation department at the Mater Hospital and in the simulation centre at the College of Anaesthetists here in Dublin.
New Challenges in Heart Transplantation
The expanding indications for heart transplantation have created a gap between the supply of donor’s hearts and increasing demand from recipients. The prevalence of heart failure in Ireland is set to increase so that by 2046 it is estimated there will be up to 190,000 patients treated for heart failure (1). This comes from an ageing population, a rising incidence of diabetes and an increase in coronary artery disease. Children with complex congenital heart disease are now reaching adulthood due to improved cardiac surgical techniques and postoperative care. A significant number of these adults will develop ventricular dysfunction and require heart transplantation.
What solutions are available to address this imbalance? Mechanical circulatory support in the form of left ventricular assist devices have become prevalent, and up to 50% of patients waiting for heart transplantation are now bridged with mechanical circulatory support(2). The proportion of left ventricular assist devices (LVAD) implanted for destination therapy has also progressively increased towards 50% with overall survival at 81% at 12 months, and 70% at 24 months (3)
The advent of a transportable organ care system enabling both standard and marginal hearts to be preserved may help the donor organ pool. The use of ex-vivo heart perfusion system with oxygenated and nutrient enriched blood to reduce ischaemic injury as distinct from the traditional cold ischaemic storage may allow retrieval of more hearts.
1) The cost of heart failure in Ireland- Heartbeat –trust.ie 2015.
2) ISHLT 34th Adult heart Transplantation report. Journal of Heart and Lung Transplantation, Vol 36, No 10, October 2017.
3) 8th annual INTERMACS report. Journal of Heart and Lung Transplantation, Vol 36, No 10, October 2017.