Actress Charlotte Valandrey has died aged 53. She had just received a new heart, “the third”. A heart transplant is a surgical procedure that involves replacing a diseased heart with a healthy one.
[Mise à jour le 14 juillet 2022 à 15h18] Actress Charlotte Valandrey died at the age of 53 at the Pitié Salpêtrière hospital in Paris, her agent told AFP on July 13. “On June 14, Charlotte had to have emergency surgery to replace her ‘second-hand heart’ as she called it, but this news graft didn’t take, this third heart has not lived“, explained her daughter, her sister and her father in a press release. HIV-positive since she was 18, the actress followed a triple therapy which weakened her heart. She had undergone a first transplant in 2002 at the age of 34. A heart transplant patient runs the first risk of transplant rejection. His immune system recognizes the organ given to him as foreign and will have as a first reaction of attack it to destroy it. Rejection is a physical, natural reaction, which is combated by partially blocking the functioning of the immune defense system. Drugs are used for this.immunosuppressants“. “Increasingly effective and controlled, immunosuppressive treatments have undesirable effects. They have the disadvantage of making the body more vulnerable to infectious diseases (viral, bacterial, fungal) and cancerous tumors” explains theBiomedicine Agency. According to the Biomedicine Agency in 2019, 5,897 transplants were practiced in France, of which 425 heart transplants.
Definition: what is a heart transplant?
A heart transplant is usually the replacing a failing heart of one person with the heart of another person who has been declared brain dead by the medical profession. There are different types of transplant: the allograft is the most widespread, the donor and the recipient are in this case of the same species; the heterograft is exceptional and occurs between individuals of different species. “These are anecdotal compared to the number of transplants performed every year in France and around the world. They remain experimental.“, emphasizes Professor Paul Menu, heart surgeon. The heart transplant is possible from tissue group and not on the basis of the sex or origin of the persons concerned. “We can very well put a heart of a man to a woman, a heart from an Asian to a Caucasian. Can also insert an artificial heart in certain situations when the health of the patient waiting for a heart is deteriorating“.
What is the lifespan of a transplanted heart?
The average lifespan of a transplant recipient is more than 10 years. “The oldest French heart transplant recipient, Emmanuel Vitria, lived in Marseille for twenty-two years“.
Indications: when to do a heart transplant?
Half of the indications for a heart transplant are dilated cardiomyopathy (DCM), heart muscle diseases with no apparent cause and no drug treatment. The second indication (25% of transplants) is related to problems heart failure due to coronary problems: “when the arteries of the heart, the coronary ones, are too damaged, they cannot be dilated or bridged or they have already been dilated and the heart is still not well, and the patients concerned are young i.e. less than 50 years old“, he adds. The third indication (25%) is related to infectious problems.
► The first step is registration of the patient on the national list waiting for transplants. This is considered by cardiologists from the moment the treatments conventional therapies no longer provide answers and the patient is under the age of 60. His file is studied to ensure his eligibility: the tissue group, the HLA group and the blood group will be added to better consider the recipient-donor compatibility. All files on the waiting list are managed by the France Transplant association.
“The operation is heavier: 24 hours in intensive care then 2 to 10 days in an isolated room to avoid infections, especially with immunosuppressive drugs”.
► The second step is to a brain dead donor. This will be decreed by two resuscitators independent of the transplant of the future recipient. “The brain dead patient only has a life expectancy of 48-72 hours. It is necessary that the diagnosis be made quickly and know if there is no non-consent for the removal of one of his organs“, notes Professor Menu. ► The donor’s file is then sent to France Transplant, which will manage the accounting between donor and recipients based on blood group and tissue group in particular. A selection of 2 to 3 recipient files is established. The regulator will then contact the departments concerned and analyze the degree of urgency of each of the patients awaiting a transplant in order to choose the recipient, within a limited period of time.
► Once the recipient has been selected, the removal and graft preparation teams will set up remotely. “Today, all samples are multi-organ : we can therefore take the kidneys, the lungs and sometimes the liver at the same time, and especially the heart last. The quality of the graft will be checked before transplantation“. Heart transplantation is a technically simple operation: the whole heart is thus sutured. “The operation is heavier for the patient due to immunological problems, rejection: 24 hours in intensive care then 2 to 10 days in an isolated room to avoid infections, especially with immunosuppressive drugs“. An artificial heart, completely mechanical, can be transplanted in the context of “super emergency” when the patient on the waiting list deteriorates significantly. “This assistance can provide relief while waiting for a heart transplant. There are less than 5 patients/year who live a year or even two full years with an artificial heart and circulatory assistance while waiting for a biological transplant“, he underlines.
Recipients must be under 65 years old.
Who can receive a heart transplant?
Of the men, women under 60-65 and children over 5 years old can receive a heart transplant. “There are very few heart transplants in children – less than 5 per year – due to growth complications with treatment with immunosuppressants. In adults, age and any other comorbidities will have to be taken into account. into account“. The average age of heart transplant recipients is 44 years.
Who can give his heart?
Everyone can give their heart, except those with blood disease (blood disease), a cancer or who have died by medication (adolescent suicide with medication) and patients over 65 years of age. “The samples are generally taken from patients who have suffered a car or motorcycle accident, aged 25 to 40 years old.“.
What is the cost of a heart transplant and what reimbursement?
Heart transplant is one of the diseases covered 100% by Social Security. “Overall, a heart transplant costs society between 150 and 200,000 euros. In large departments with intensive care units reserved for transplants such as Pitié-Salpêtrière or Bordeaux, the large volume of patients can reduce costs“.
The people live very well with a transplanted heart: “You should know that these are often people who have been very sick for years, who have lived in extreme situations, living under an electric blanket to maintain their body temperature, being unable to wash themselves, to comb, and who with transplant revive“, says Professor Menu. Women who have had a heart transplant can follow a pregnancycan play sports. The constraints are those of the daily immunosuppressive treatment and the risk of infections.
Thank you to Pr Paul Menu, professor emeritus, cardiac surgeon at the University Hospital of Poitiers and member of the French Federation of Cardiology (FFC) and of the ethics commission of the FFC.