Heterotopic heart transplantation

 

Heterotopic heart transplantation, also known as the “piggyback” or “double heart” transplant, involves implanting a donor heart alongside the recipient’s native heart rather than replacing it. This technique is particularly useful in patients with high pulmonary vascular resistance or when donor-recipient size mismatch is a concern. Donor heart procurement for heterotopic transplantation follows standard organ recovery protocols, including careful cardioplegia, excision with adequate atrial cuffs, and preservation in cold storage or a perfusion system. Once the donor heart is transported to the recipient center, intra-abdominal reimplantation is performed, typically positioning the donor heart in a heterotopic configuration within the abdominal cavity or lower mediastinum, connecting the systemic and pulmonary venous inflows and arterial outflows to the native circulation. This approach allows partial support of the recipient’s circulation, provides redundancy in cases of graft dysfunction, and can serve as a bridge to orthotopic transplantation or long-term cardiac support.