Two simultaneous heart and lung transplants in Gdansk

The chief operating surgeon and the doctor with substantive supervision over the entire procedure and treatment was Jacek Wojarski , MD, from the UCK Department of Cardiac Surgery, coordinator of the lung transplant program. He is a specialist cardiac surgeon and clinical transplantologist who has many years of experience in both heart and lung transplantation. Dr. Wojarski, along with two colleagues - Slawomir Zeglen, MD, and Wojciech Karolak, MD - were hired at UCK in 2018 to implement a lung transplant program in Gdansk in addition to their work in the Department of Cardiac Surgery.

For patients whose disease had led to irreversible changes in both organs, simultaneous heart and lung transplants were the only chance for survival. During the hours-long procedures, a large team of surgeons and anesthesiologists, instrumentation and anesthesia nurses, as well as a team of perfusionists operating the extracorporeal circulation apparatus - necessary for these operations - worked in the operating room. At the same time, a separate team, consisting of two cardiac surgeons, an anesthesiologist and an instrumentation nurse, participated in the procurement of organs: heart and lungs in hospitals where donors were submitted. The coordination of these teams and the logistics of the procedures were supervised by the transplantation action coordinators.

Successful simultaneous lung and heart transplant operations were performed on a 54-year-old man and a 37-year-old woman. In the case of the man, the transplant was performed last December, while the woman received her new organs in June of this year.

- We want to announce the restoration of this method, this treatment technique for a rare but important group of patients for whom heart transplantation alone or lung transplantation alone or the use of the latest organ support techniques and drug treatment cannot be used. Such a group of patients has clearly become selective in recent years, and they, without this type of transplantation, are doomed to a premature death," says Jacek Wojarski, MD, chief surgeon-operator of both transplants.

As the doctors point out, these were two different cases in terms of the cause. - In the patient's case, we were dealing with a disease that is more commonly seen in pulmonology, while the patient was treated by cardiologists. The 54-year-old suffered from sarcoidosis, which led to profound pulmonary impairment and profound cardiac impairment. The patient, on the other hand, developed very severe idiopathic pulmonary arterial hypertension in a very advanced form. As a result of this hypertension, she developed very severe myocardial damage. In both cases, the only way to avoid premature death was to perform just this type of transplantation, the transplantologist explains.

Simultaneous lung and heart transplant operations are complex procedures that take several hours at a time. What is equally challenging, however, according to doctors, is managing the patient after the procedure. - This is because the lungs need different hemodynamic conditions or pharmacotherapy than the transplanted heart. This "conflict" between organs is sometimes difficult to resolve, but we are prepared for such problems. We have a great, experienced team and world-class equipment," says Professor Romuald Lango of the UCK Department of Anesthesiology and Intensive Care. Professor Lango led the anesthesia of UCK's first lung transplant in 2018.

In the process of qualifying these patients for transplantation, a broad team of specialists worked together, including from the Department of Cardiac Surgery (lung transplantation unit), the Department of Anesthesiology and Intensive Care, the Department of Allergology and Pneumonology, the 2nd Department of Cardiology and Cardiac Electrotherapy. Such advanced cooperation allows us to delve into the patient's condition with details and make decisions about differences in intraoperative and postoperative management. Imaging study information from the Department of Radiology and studies from the Immunology Laboratory are invaluable. If a patient is diagnosed with other concomitant diseases, doctors from the relevant clinics consult these patients and discuss methods of appropriate treatment. The role of physiotherapists both in the preoperative period and in postoperative management cannot be overstated either. As a result of this multidisciplinary work, the transplant team that makes the final decision on qualifying a patient for transplantation has a very broad knowledge of the patient.

According to Jakub Kraszewski, such cooperation is the basis of modern medicine. - I am proud that our multidisciplinary, very broad team is doing such great things. This shows what possibilities, what effect is given by cooperation, collaboration and support of specialists," says the director. - Such results are possible not because we have a modern building, state-of-the-art infrastructure or the best available equipment, but because we are well organized and rely on cooperation. I would like to thank the medical and non-medical staff, and congratulate the patients on their recovered health," adds Professor Marcin Gruchała, MD, rector of the Medical University of Gdansk and head of UCK's 1st Cardiology Clinic.

The University Clinical Center currently has four people waiting for simultaneous lung and heart transplants. According to doctors, the Gdansk center could perform up to five such operations annually. For the first time in Poland, a successful operation in which a patient simultaneously received a new lung and heart was carried out in 2001. It was performed by specialists from the Silesian Center for Heart Diseases in Zabrze.

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