Heart Transplant
Definition
This is surgery to remove a severely diseased and failing heart. It is replaced with a healthy heart from a deceased donor.
| Normal Heart and Heart With Hypertrophic Cardiomyopathy |
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Reasons for Procedure
A heart transplant is done if you have:
- End stage heart disease that is life threatening and cannot be fixed (but you are in otherwise good health)—This is most often due to cardiomyopathy (disease of the heart muscle) with severe congestive heart failure.
- Severe coronary artery disease that cannot be fixed with medicine or other surgeries
- Congenital heart defects
- Valvular defects making it too hard for the heart to pump blood through the body
- Uncontrollable life-threatening irregular heart rhythms
Possible Complications
If you are planning to have a heart transplant, your doctor will review a list of possible complications, which may include:
- Infection
- Rejection of the new heart
- Coronary artery disease (50% of all heart-transplant recipients develop coronary artery disease)
- Pneumonia
- Blood clots
- Bleeding
- Decreased brain function
- Damage to other body organs, such as the kidneys
- Irregular heart rate
- Anesthesia-related problems
- Infection or cancer related to taking immunosuppressive medicines
- Death
More than 80% of heart transplant patients live for at least one year after surgery. Most return to normal activities, including work and exercise.
Some factors that may increase the risk of complications include:
- Age: 60 or older
- Lung disease
- Poor circulation
- Kidney or liver disease
- Smoking
- Presence of serious active infection, such as pneumonia or tuberculosis
- Treatment for cancer within the past five years
- Debilitation and malnourishment
- Uncontrolled diabetes
- Previous stroke or other damage to the blood vessels of the brain
- Continued substance abuse or alcohol abuse
- Autoimmune disease
Be sure to discuss these risks with your doctor before the procedure.
What to Expect
Prior to Procedure
There is a shortage of donors, so you may be on a transplant list for some time. You may need to carry a cell phone with you at all times. This is to allow the transplant team to reach you if a donor heart becomes available. You may need to stay in the hospital for monitoring. You may need to be on continuous IV medicines to help stabilize the function of your diseased heart. Some may need to have a mechanical pump called a ventricular assist device (VAD). The device will help to stabilize your heart while you are waiting for a transplant.
- Your doctor will monitor your health to make sure that you are ready for the heart transplant.
- Talk to you doctor about all medicines you are taking. You may be asked to stop taking aspirin or other anti-inflammatory drugs for one week before surgery. You may also need to stop taking blood-thinning medicines, such as Clopidogrel (Plavix) or Warfarin (Coumadin).
- Do not take over-the-counter medicine without checking with your doctor.
- Arrange for a ride to and from the hospital.
- Arrange for help at home after the surgery.
- Eat a light meal the night before the surgery. Do not eat or drink anything after midnight.
Before the surgery, your doctor will likely do the following:
- Physical exam
- Cardiac catheterization
- Echocardiogram —a test that uses high-frequency sound waves (ultrasound) to examine the size, shape, and motion of your heart
- Identify your blood and tissue type
- Tests to exclude diseases in other organ systems that may prevent you from receiving a transplant
Anesthesia
General anesthesia
will be used. It will block pain and keep you asleep through the surgery. It is given through an IV in your hand or arm.
Description of the Procedure
After you are asleep, the doctor will cut through the skin and breastbone. She will open the chest and connect you to a heart-lung machine. This machine takes over the functions of the heart and lungs during surgery. The doctor will then remove your heart. The donor heart will be prepared and sewn into place in your chest. Next, the blood vessels will be connected. After this, the blood will start to flow and warm the heart.
The new heart may begin beating on its own, or the doctor may give you an electrical shock to get your heart started. For safety, you will also have a temporary pacemaker attached to the heart to help the heart beat stay regular. Once the doctor is sure that the heart is beating fine, the blood will be rewarmed. The heart-lung machine will be disconnected. Next, temporary tubes may be placed in the chest cavity to drain any blood that has collected. The doctor will close the chest with stainless steel wires. Lastly, the skin will be closed with absorbable sutures.
Immediately After Procedure
You will be closely monitored in the intensive care unit (ICU) with the help of some/all of the following devices:
- Heart monitor
- Pacing wires used to help the heart beat normally
- Tubes connected to a machine that helps drain excess blood and air
- Breathing tube, until you can breathe on your own
How Long Will It Take?
8 hours
Will It Hurt?
You will have pain during the recovery process. Your doctor will give you pain medicine.
Average Hospital Stay
This procedure is done in a hospital setting. The usual length of stay is at least two weeks. Your doctor may choose to keep you longer if you shows signs of rejecting the new heart or have other problems.
Post-procedure Care
At the Hospital
While you are recovering at the hospital, you will need to:
- Breathe deeply and cough 10-20 times every hour.
- Take immunosuppressive drugs—You will likely need to take these for the rest of your life. These drugs reduce the chance that your body will reject the new heart.
Your doctor may need to take a
biopsy
of your heart routinely and additionally as needed if you:
- Have persistent fever
- Have poor heart function
- Do not feel well
At Home
When you return home, do the following to help ensure a smooth recovery:
- Take medicines as directed.
- Return as prescribed by your transplant cardiologist for follow up biopsies.
- Work with a physical therapist. Keep in mind that your new heart will respond slowly to increases in physical activity.
- Ask your doctor about when it is safe to shower, bathe, or soak in water.
- Be sure to follow your doctor's instructions .
The surgical site in your breastbone will heal in 4-6 weeks.
Call Your Doctor
After you leave the hospital, contact your doctor if any of the following occur:
- Signs of infection, including fever and chills
- Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision site
- Changes in sensation, movement, or circulation in your arms or legs
- Changes in the location, type, or severity of pain
- Chest pain, pressure, or a return of your previous heart pain
- Fast or irregular heart rate
- Pain that is unrelieved
- Cough, or shortness of breath
- Coughing up blood
- Severe nausea or vomiting
- Sudden headache or feeling faint
- Waking up at night due to being short of breath
- Excessive tiredness, swelling of feet
- Pain, burning, urgency, frequency of urination, or persistent bleeding in the urine
In case of an emergency,
get medical care right away
.
RESOURCES
Scientific Registry of Transplant Recipients http://www.ustransplant.org
Transplant Living http://www.transplantliving.org
CANADIAN RESOURCES
Health Canada http://www.hc-sc.gc.ca
Heart and Stroke Foundation of Canada http://ww2.heartandstroke.ca
References
Heart transplant. American Heart Association website. Available at: http://www.americanheart.org/presenter.jhtml?identifier=3066619 . Updated May 2009. Accessed July 21, 2009.
What is a heart transplant? National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov/health/dci/Diseases/ht/ht%5Fwhatis.html . Updated September 2008. Accessed July 21, 2009.
