Cardiac transplantation and mechanical assistance.

The era of human heart transplantation began in 1967 by Dr. Christian Barnard in South Africa. Unfortunately, most patients died within the first year after transplantation from rejection or opportunistic infection, and the procedure was abandoned in all but a few centers. With the dedicated work of Dr. Norman Shumway from Stanford University, advances in immunosuppression and improved detection and management of rejection allowed heart transplantation to evolve from a laboratory curiosity into a clinical reality. Finally, with the introduction of the immunosuppressant, Cyclosporin A (CyA), in the 1980s the number of cardiac transplants being performed increased exponentially. Heart transplantation has entered the mainstream of surgical management of congestive heart failure and approximately 2000 procedures are performed annually in the United States and 3000 worldwide.