Heart transplantation has become the accepted treatment for end-stage heart failure caused either by dilated cardiomyopathy or cardiac scarring from coronary artery disease. First performed by Dr. Christiaan Barnard of Capetown, South Africa in 1967, heart transplantation has been one of the greatest challenges of all, primarily due to rejection. Eventually, management of this problem was simplified with the introduction of the anti-rejection drug, Cyclosporine and also utilization of percutaneous right heart ventricular muscle biopsy enabling early detection. When it became apparent that heart transplantation could be performed successfully in a hospital that had an active cardiac surgical program, it was decided to begin such a program at St. Thomas Hospital. The first heart transplant in Tennessee was done here by our group in 1985 and more than 200 transplants have been done subsequently. In 2000, there were 12 heart transplant procedures done at St. Thomas Hospital with a 100% one-year survival. There continued to be long-term concerns after heart transplantation, including graft rejection, certain infections, renal insufficiency secondary to Cyclosporine, graft coronary atherosclerosis and development of certain neoplasms.

The most frustrating part of a transplant service is the short supply of donor organs and having patients die while waiting for a suitable match. Addressing this problem, there has been a large effort made to develop a temporary or permanent mechanical heart assist device, or totally implantable artificial heart. This is a simple concept, but a tremendous technological challenge that has yet to achieve long-term success. Short-term use of single ventricle mechanical heart bypass devices has been approved for use as a bridge to transplantation. St. Thomas Hospital has been using the Heart Mateä for this purpose for five years and are pleased with its function.