Definition

This is a surgical procedure to remove a severely diseased and failing heart and replace it with a healthy heart from a deceased donor.

Normal vs. Diseased Heart

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Parts of the Body Involved

Heart, chest

Reasons for Procedure

A heart transplant is done to treat irreversible, life-threatening heart diseases that cannot be managed using any other type of medical or surgical method. Transplant recipients are severely disabled by their heart condition but are otherwise in good health. The procedure is most often performed for the following reasons:

Risk Factors for Complications During the Procedure

What to Expect

Prior to Procedure

Because of a shortage of donors, you may be on a transplant list for some time. You may need to carry a pager or cellular phone at all times so that the transplant team can reach you if a donor heart becomes available.

Since most heart donors may come at any time, your doctor will continuously monitor your health and have you ready for surgery. Your doctor will likely have done the following:

  • Physical exam
  • Echocardiogram —a test that uses high-frequency sound waves (ultrasound) to examine the size, shape, and motion of the heart
  • Tissue typing
  • Identify your blood group

In the days leading up to your procedure:

  • Arrange for a ride to and from the hospital.
  • Arrange for help at home after returning from the hospital.
  • Take medications as directed and do not take over-the-counter medications without checking with your doctor.
  • The night before, have a light meal and do not eat or drink anything after midnight unless told otherwise by your doctor.

During Procedure

  • IV fluids
  • Oxygen
  • Anesthesia
  • Diversion of circulation through a heart-lung machine

Anesthesia

General

Description of the Procedure

The surgeon cuts through the skin and breastbone, opens the chest, and connects you to a heart-lung machine. This machine takes over the functions of the heart and lungs during the operation. Doctors remove all but the back wall of the upper chamber of the heart. The upper chambers of the donor heart are opened, and the donor heart is sewn in place. Next, the blood vessels are connected, and the blood starts to flow and warms the heart.

The new heart may begin beating on its own or doctors may administer an electrical shock to get it started. For safety, you will also have a temporary pacing wire attached to the heart. Once doctors are sure that the heart is beating fine and no further problems are anticipated, the blood is rewarmed, the heart-lung machine disconnected, and catheters are placed in the chest cavity to drain any residual blood that may collect. The surgeon closes the chest with stainless steel wires and the skin is closed with absorbable sutures.

After Procedure

You'll be closely monitored in the intensive care unit with the help of the following devices:

  • Heart monitor
  • Pacing wires used to help control heart rate
  • Tubes connected to a machine that helps drain excess blood and air
  • Breathing tube until you can breathe independently

How Long Will It Take?

4-6 hours

Will It Hurt?

Anesthesia prevents pain during surgery. You'll likely experience pain while recovering, but you will receive drugs to relieve the discomfort.

Possible Complications

  • Infection
  • Rejection of the new heart
  • Coronary artery disease (half of all heart-transplant recipients develop coronary artery disease)
  • Pneumonia
  • Phlebitis (blood clots of a vein)
  • Excessive bleeding
  • Neurological deficits, stupor, coma , decreased intellectual function
  • Kidney dysfunction
  • Irregular heart rate
  • Anesthesia-related problems
  • Infection or cancer related to taking immunosuppressive medications
  • Death

Average Hospital Stay

Two weeks, if there are no signs of rejecting the new heart

Postoperative Care

  • Breathe deeply and cough 10-20 times every hour.
  • Take immunosuppressive drugs and other medications as directed by your doctor; only take drugs approved by your doctor.

Outcome

The surgical site in your breastbone heals in 4-6 weeks.

To reduce the chance that your body will reject the donor heart, you will need to take immunosuppressive drugs for the rest of your life. Your doctors will biopsy your new heart only if there are signs like persistent fever, poor heart function, shortness of breath, or if you do not feel well. Additional drugs may be ordered to manage side effects. These drugs may increase your risk of developing cancer, kidney disease, and weak bones. You will be monitored by specialists who understand these medications and you will have regular blood check-ups to ensure that you do not develop any side effects from these strong medications.

More than 80% of heart-transplant patients live for at least one year following the surgery. Most return to normal activities, including work and exercise. A specific rehabilitation program may be suggested to speed recovery and restore cardiovascular health. The transplanted heart responds slowly to increases in physical activity.

Call Your Doctor If Any of the Following Occurs

  • Signs of infection, including fever and chills (You are more susceptible to infections while taking immunosuppressive medications.)
  • Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision site
  • Cough, shortness of breath, chest pain, or severe nausea or vomiting
  • Coughing up blood
  • Sudden headache or feeling faint
  • Sensation of your heart fluttering, missing beats, or beating erratically
  • Pain, burning, urgency, frequency of urination, or persistent bleeding in the urine
  • Excessive tiredness, swelling of feet
  • Waking up at night due to being short of breath