Heart transplantation and cardiac devices
- Topic
Replacing a failing heart or valve saves lives but brings its own problems: rejection, clots, infection and wear.
What it is
Heart transplantation treats end-stage heart failure. The main problems are acute rejection (T-cell mediated or antibody-mediated), infections and tumours from immunosuppression, and cardiac allograft vasculopathy, a diffuse concentric intimal thickening of the coronary arteries that limits long-term survival. Prosthetic valves are mechanical (durable, but needing anticoagulation) or bioprosthetic (tissue valves that degenerate and calcify). Ventricular assist devices support a failing ventricle but risk thrombosis, bleeding, stroke and infection.
Complications of replacing the heart or its valves
| Treatment | Main complications | Pathology | Timing |
|---|---|---|---|
| Heart transplant | Rejection, infection, lymphoma | Lymphocytic infiltrate with myocyte injury; C4d in capillaries | Weeks to years |
| Heart transplant (late) | Allograft vasculopathy | Diffuse concentric intimal thickening of coronary arteries | Years |
| Mechanical valve | Thrombosis, embolism, bleeding, endocarditis | Thrombus on the valve; ring abscess | Any time |
| Bioprosthetic valve and assist device | Calcification and tears (valve); thrombosis, driveline infection, bleeding (device) | Dystrophic calcification; thrombus; infection | Years (valve); months (device) |
Clinical notes
- Transplant recipients undergo surveillance biopsies and coronary imaging; chest pain is often absent in vasculopathy.
Test yourself
Think of the answer, then tap the question to see it.
What is cardiac allograft vasculopathy?
A diffuse, concentric intimal proliferation of the coronary arteries of a transplanted heart, the main limit to long-term graft survival.
Why do mechanical valves require lifelong anticoagulation?
Their surfaces are thrombogenic, so without anticoagulation thrombi form and embolise.
What is the main long-term failure mode of bioprosthetic valves?
Structural degeneration with calcification and leaflet tears.
Elsewhere in DurgiPedia
Connections
Educational content on the mechanisms of disease; not a diagnostic or treatment guide and no substitute for a health professional's advice. No doses are given.
Sources: Heart Transplantation | Heart Transplant | MedlinePlus (MedlinePlus, US National Library of Medicine, 2025); Infective Endocarditis (StatPearls (NCBI Bookshelf), 2025).
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Representative model, for educational purposes only.