Vladimir Demikhov

End-stage heart failure: The future of heart transplant and artificial heart

In the last decades, outcomes significantly improved for both heart transplantation and LVAD. Heart transplantation remains the gold standard for the treatment of end stage heart failure and will remain for many years to come. The most relevant limitations are the lack of grafts and the effects of long-term immunosuppressive therapy that involve infectious, cancerous and metabolic complications despite advances in immunosuppression management. Mechanical circulatory support has an irreplaceable role in the treatment of end-staged heart failure, as bridge to transplant or as definitive implantation in non-transplant candidates. Although clinical results do not overcome those of HTx, improvement in the new generation of devices may help to reach the equipoise between the two therapies. This review will go through the evolution, current status and perspectives of both therapeutics.

Vladimir P. Demikhov, a pioneer of organ transplantation

Vladimir P. Demikhov was born in a Russian peasant family in 1916. As a biology student at The Moscow University in 1937, he constructed a metal artificial heart and maintained the circulation of a dog for 5.5 hours. From 1946, after his military service, he worked in the Surgical Institute of The Moscow Academy of Sciences performing heterotopic heart transplantations in dogs. In 1947, he performed the first orthotopic lung transplant. Later he performed complex cardiothoracic transplantations as well as renal and hepatic transplantations. He restarted his investigations with the artificial heart and performed coronary bypass operations in dogs. In 1954 he performed a head transplantation, for which he gained worldwide infamy. Stalinist propaganda advertised this fact as the superiority of Soviet science. In fact, it was the upper body of a smaller dog to the neck of a bigger one. The two heads could eat and drink separately. But he could not overcome the problems of rejection, so the longest survival was 1 month among 20 such operations. His influence on the pioneers of transplantation is unquestionable. He was an innovative creative man, and many pioneers of transplantation highly appreciated his work. Demikhov contributed to clinical heart and lung transplantation by demonstrating the possibility of their experimental realization; furthermore, he motivated the pioneers of coronary bypass operations with his work. He died in 1998, but before that was honored with a high state award and the "Pioneer Award" of the International Society for Heart and Lung Transplantation.