Heart Transplant Overview

This is surgery to remove a severely diseased and failing heart. It is replaced with a healthy heart from a deceased donor.

Normal vs. Diseased Heart © 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 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 medicine 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 doctors 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'll 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.
• Be sure to follow your doctor's instructions .

The surgical site in your breastbone will heal 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://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_whatis.html . Updated September 2008. Accessed July 21, 2009.