A technique for normothermic orthotopic heart transplantation in the adult dog is described in detail. A brief review of the results of the first twenty transplantations performed during the development of the technique is presented. Only once did the transplanted heart fail to perfuse the recipient. One animal survived for 11 days. The known causes of death in hearts transplanted by this technique are discussed. Sudden death due to unknown causes occurred in several animals after twelve hours to 2 1 2 days of excellent homograft heart function. The determination of the exact cause of death of this group of animals will most likely have to await the development of new knowledge of the biochemical behavior of homografted hearts.
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