A surgical procedure designed to remove severely diseased and damaged heart and lungs and replace them with a healthy heart and lungs from a donor who has recently died.
A heart-lung transplant is done to treat irreversible, life-threatening lung diseases that affect the heart and cannot be managed using any other medical or surgical treatment. Transplant recipients are severely disabled by their heart-lung condition but otherwise are in good health. The procedure is most often performed on patients with severe
pulmonary hypertension
(an increase in blood pressure in the lung's blood vessels), either acquired or due to a birth defect.
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 donor organs become available.
Your doctor will likely do the following:
Physical exam
Order appropriate blood tests to ensure your liver and kidney are functioning normally
Have your blood typed and ready for surgery
Tissue typing
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 blood circulation through a heart-lung machine
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 the lungs and all but the back walls of the upper chamber of the heart. The donor lungs are attached, then the upper chambers of the donor heart are opened, and it is sewn into 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. Once the doctors are sure no leaks exist and the heart and lungs are working fine, the heart-lung machine is disconnected, the breastbone wired together, and the chest closed. You will have many tubes and lines on your chest and body to monitor your heart and blood pressure.
After Procedure
You'll be closely monitored in the intensive care unit, with the help of the following devices:
Heart monitor
Pacing wires to help control heart rate
Tubes connected to a machine that helps drain excess blood and air
Breathing tube until you can breathe independently, then an oxygen mask
How Long Will It Take?
Several hours
Will It Hurt?
Anesthesia prevents pain during surgery. You'll likely experience some pain while recovering but receive drugs to relieve the discomfort.
Possible Complications
Infection
Rejection of the donor heart or lungs
Coronary artery disease
(half of all heart-transplant recipients develop coronary artery disease)
Neurological deficits, stupor,
coma
, decreased intellectual function
Kidney dysfunction
Irregular heart rate
Anesthesia-related problems
Cancer
related to taking immunosuppressant medications
Death
Average Hospital Stay
Two weeks, if there are no signs of rejecting the new organs
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.
A specialist who deals with immunosuppressive drugs will monitor your medications, and the surgeons will monitor your heart and lungs.
Outcome
The surgical site in your breastbone heals in 4-6 weeks.
To reduce the chance that your body will reject the donor organs, you will need to take immunosuppressive drugs for the rest of your life. Your doctors will only
biopsy
your new heart/lungs if you have signs of rejection. 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 have regular blood work and physical exams to monitor your heart and lungs.
About 60% of heart-lung transplant patients live more than one year after 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
Swelling of feet
Waking up at night feeling short of breath
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
RESOURCES:
Scientific Registry of Transplant Recipients http://www.ustransplant.org
Transplant Living http://www.transplantliving.org
CANADIAN RESOURCES:
Heart and Stroke Foundation of Canada http://ww2.heartandstroke.ca/Page.asp?PageID=24
University of Ottawa Heart Institute http://www.ottawaheart.ca/UOHI/Welcome.do
References:
American Heart Association website. Available at:
http://www.americanheart.org/presenter.jhtml?identifier=1200000
.
National Heart, Lung, and Blood Institute website. Available at:
http://www.nhlbi.nih.gov/
.
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
