Introduction

Experimentation into the feasibility of heart–lung transplantation began about 60 years ago. Demikhov performed the operation in dogs but had no long-term survivors because of the development of abnormal respiratory patterns in the recipients [1]. Subsequently Castaneda performed the operation in primates and achieved long-term survivors [2]. Cooley carried out the first clinical heart–lung transplantation in 1968 in a 23 month old girl with a complete atrioventricular septal defect but she survived for only 14 hours [3]. In 1969 Lillehei performed transplantation on a 43 year old man with emphysema who survived 8 days [4]. In 1971 Barnard operated on another patient with chronic lung disease who survived 23 days [5].

The first human heart–lung transplantation that resulted in long-term survival was carried out in Stanford, USA, in 1981; the patient was a 45 year old woman with primary pulmonary hypertension [6]. The first heart–lung transplantation at Harefield Hospital, UK, was performed in 1983; our longest survivor is a woman diagnosed with primary pulmonary hypertension and operated on in 1984 at 14 years of age [7]; she is still alive with her original graft. By 1985, 14 centres worldwide were carrying out heart–lung transplantation, predominantly for pulmonary vascular disease [8].

The rationale for combined transplantation of the heart and the lungs was that patients with pulmonary hypertension usually have concomitant cardiac abnormalities either as the cause of the pulmonary hypertension (Eisenmenger's syndrome) or right ventricular hypertrophy and failure secondary to the pulmonary hypertension (as in primary pulmonary hypertension).