Heart-Lung Transplant Overview

This is a surgery to remove a severely diseased and damaged heart and lungs. They are replaced with a healthy heart and lungs from a deceased donor.

The Heart and Lungs © 2009 Nucleus Medical Media, Inc.

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 organs become available.

Your doctor will monitor your health to make sure that you are ready for the transplant. Before the surgery, your doctor will likely do the following:

• Physical exam
• Blood tests—to make sure your liver and kidneys are functioning normally
• Identify your blood group
• Tissue typing

Leading up to the surgery:

• Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure, like:

• Anti-inflammatory drugs (eg, aspirin )
• Blood thinners, like 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.

Anesthesia

General anesthesia will be used. It will block any 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 the surgery. The doctors will then remove the lungs and the heart. The donor lungs will be attached. Then, the doctor will sew the new heart into place. Next, the blood vessels will be connected. 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 the heart started. The doctor will make sure that there are no leaks and that the heart and lungs are working fine. After this, 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 breastbone will be wired together, and the chest will be closed.

Immediately After Procedure

You will be closely monitored in the intensive care unit (ICU) 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 from the chest cavity
• Breathing tube, until you can breathe on your own

How Long Will It Take?

Several hours

How Much Will It Hurt?

You will have pain during the recovery process. Your doctor will give you pain medicine.

Average Hospital Stay

This surgery is done in a hospital setting. The usual length of stay is two weeks. Your doctor may choose to keep you longer if you shows signs of rejecting the new organs or have other problems.

Postoperative Care

At the Hospital

While you are recovering at the hospital, you will need to:

• Breathe deeply and cough 10-20 times every hour to help keep your lungs working well.
• 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 or lungs 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.
• Work with a physical therapist. Keep in mind that your new heart will respond slowly to increases in physical activity.
• Be sure to follow your doctor's instructions.

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

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/index_e.html/

Heart and Stroke Foundation of Canada
http://www.heartandstroke.ca/

References:

Surgery and other medical procedures for heart failure. American Heart Association website. Available at: http://www.americanheart.org/presenter.jhtml?identifier=123 . Updated April 2009. Accessed September 4, 2009.

What is a lung transplant? National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov/ . Updated December 2008. Accessed September 4, 2009.