– The survival of patients is the measure of the quality of transplantology. Both in the perspective of 30 days, a year and 10 years. The second factor is the number of treatments, the third – distant results, i.e. the patient’s condition, e.g. after 10 years – says Dr. Michał Zembala, Coordinator of the Department of Cardiac Surgery, Heart and Lung Transplantation and Mechanical Circulation Support at the Silesian Center for Heart Diseases in Zabrze. On January 26, we celebrate the National Transplant Day.
- This is a good time for Polish transplantology. There are more and more donors reported, and the quality of treatments is getting better – says Dr. Michał Zembala, cardiac surgeon in an interview with Medonetem.
- According to statistics, 70 percent. people with a transplanted heart survive 10 years
- The problem is the rising costs of care and treatment of people after transplantation, Dr. Zembala calls for a new, updated valuation of procedures
- You can find more such topics on the TvoiLokony home page
Read the first part of the conversation with the cardiac surgeon Michał Zembala: Last year we broke the Polish record in the number of heart transplants
Adrian Dąbek, Medonet: We have more and more heart donors, but it is not always possible to benefit from the human one. Then an artificial heart comes to the rescue. What is it about?
Dr. Michał Zembala: Supporting the heart with a mechanical device (LVAD, BIVAD) is a rapidly developing field of cardiology and cardiosurgery. In Poland, we are developing this treatment program in strong transplant centers in Gdańsk, Kraków, Poznań, Warsaw and Zabrze. We use chambers in patients who are qualified for transplantation and have a long waiting time for an organ or are hospitalized due to exacerbations of heart disease.
Recent studies, but also our experience, show that a patient who has a pump implanted survives just as well, with the same health and with the same quality of life for about three to five years as after a transplant. Mechanical hearts are becoming more and more perfect. Of course, longer than five years is in favor of transplantation, but these five years allow the patient to live in good health and wait for the transplant.
However, there is no target therapy with a mechanical device – that is, treatment with a pump for elderly patients who are not candidates for transplantation. The expectations of both patients and the cardiac community are significant due to the growing number of elderly patients. This solution works both in Europe and in the United States, where over 50 percent. pumps are implanted as DT – that is, target therapy. With this solution, we not only extend the patient’s life, but also improve its quality. The sick person stays at home and functions in society. The cost-effectiveness of such a solution is significant.
And at what stage are the works on the Polish artificial heart?
The Foundation for the Development of Cardiac Surgery in Zabrze participated in the French Carmat project as one of the important subcontractors and these solutions were implemented there. On the other hand, work on the Polish pump is underway and, as far as I know, they are at an intermediate level – they have undergone research in animals.
Last year was great looking at the numbers, but it can always get better. What are the biggest problems of Polish transplantology?
It is difficult for me to refer to transplantology as a whole, but from the perspective of the head of the heart transplantation center, I must admit that the time is good – there are more and more donors reported, and the quality of treatments and postoperative care is getting better. It is important that we change the criteria for a potential donor and, whenever possible, also accept the organs of 50-year-olds. By performing appropriate imaging tests – e.g. coronary angiography, we are able to assess well the structure and function of an organ that can save the life of a person of a similar age. Remember that there are many 50- and 60-year-olds waiting on the transplant lists.
Undoubtedly, the growing costs of care and treatment are a problem – hence the call for a new, updated valuation of procedures. We transplant patients who often stay in the cardiology or intensive care unit for weeks, who require weeks of intensive rehabilitation after the transplant. It all costs money. We are not wasteful at the same time – we count every zloty spent.
- The first heart transplant at the University Children’s Hospital in Krakow
For example, can a person with long diabetes be a heart donor?
If he has a coronary angiography which shows that there are no changes in the coronary arteries, then yes. Diabetes today is synonymous with the diagnosis of ischemic heart disease, but if the coronary angiography is clean and echocardiographically the heart function is normal, we collect such hearts.
How do we measure the quality of transplantology? What is the most important?
The most important thing will always be the survival of the sick. Both in the perspective of 30 days, a year and 10 years. It’s survival, or vice versa – the mortality rate should always be as low as possible. Heart transplantation, especially in urgent patients, is a difficult and demanding procedure. The 30-day mortality rate is 10-15 percent. in European Statistics. The number of transplant procedures, heart or lungs performed, is a measure of the organizational efficiency and capabilities of the center – its ambitions, intentions and plans, but also the trust of doctors who report patients for transplantation. The third element is long-term results – that is, results one, two, five, ten years after transplantation. Statistics show that 70 percent. patients live for 10 years, but please remember that this time depends on many factors. Complications of immunosuppressive treatment, infections, and chronic rejection are the most common problems of transplant patients. Their treatment requires an interdisciplinary approach and an extensive program.
- Can the coronavirus damage the heart?
What are your plans for 2021?
Together with Dr. Urlik’s team, we are preparing for a simultaneous heart and lung transplant. We want to reactivate this program, which my father started with great success this year. Our dreams are slowly coming true, we have a growing team of ambitious doctors – cardiologists, anaesthesiologists, and intensive care specialists. We were joined by specialists from many places in the country, and the resulting mosaic of characters, attitudes and knowledge is more than edifying. We have great confidence in our patients – their faith in our work, our dedication and everyday painstaking work stimulate us to continuous improvement. We train other colleagues from Ukraine who, just like us in the 80s, come to learn and use their knowledge to save their compatriots. We are very happy about all this. May 2021 be better.
Dr hab. n med. Michał Zembala – Coordinator of the Department of Cardiac Surgery, Heart and Lung Transplantation and Mechanical Circulation Support at the Silesian Center for Heart Diseases in Zabrze. Visiting professor at the Pomeranian Medical University in Szczecin.
This may interest you:
- Monika was waiting for an urgent heart transplant. Suddenly a miracle happened
- “With my body I warmed what was supposed to give me life”
- «I gave my wife a kidney so that we could live normally. It was the best way »
The content of the medTvoiLokony website is intended to improve, not replace, the contact between the Website User and their doctor. The website is intended for informational and educational purposes only. Before following the specialist knowledge, in particular medical advice, contained on our Website, you must consult a doctor. The Administrator does not bear any consequences resulting from the use of information contained on the Website. Do you need a medical consultation or an e-prescription? Go to halodoctor.pl, where you will get online help – quickly, safely and without leaving your home.