Heart-Lung Transplant

Your doctor will likely do the following: Physical examOrder appropriate blood tests to ensure your liver and kidney are functioning normallyHave your blood typed and ready for surgeryTissue 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 ProcedureIV fluidsOxygenAnesthesiaDiversion of blood circulation through a heart-lung machine AnesthesiaGeneral Description of the ProcedureThe 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 monitorPacing wires to help control heart rateTubes connected to a machine that helps drain excess blood and airBreathing 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 ComplicationsInfectionRejection of the donor heart or lungsCoronary artery disease (half of all heart-transplant recipients develop coronary artery disease) PneumoniaPhlebitis (blood clots of a vein) Excessive bleeding Neurological deficits, stupor, coma , decreased intellectual function Kidney dysfunctionIrregular heart rateAnesthesia-related problemsCancer related to taking immunosuppressant medications Death Average Hospital StayTwo weeks, if there are no signs of rejecting the new organs Postoperative CareBreathe 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. OutcomeThe 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 OccursSigns of infection, including fever and chillsYou are more susceptible to infections while taking immunosuppressive medications.Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision siteCough, shortness of breath, chest pain, or severe nausea or vomitingCoughing up bloodSwelling of feetWaking up at night feeling short of breathSudden headache or feeling faintSensation of your heart fluttering, missing beats, or beating erraticallyPain, burning, urgency, frequency of urination, or persistent bleeding in the urine RESOURCES:

Scientific Registry of Transplant Recipientshttp://www.ustransplant.org Transplant Livinghttp://www.transplantliving.org CANADIAN RESOURCES: Heart and Stroke Foundation of Canadahttp://ww2.heartandstroke.ca/Page.asp?PageID=24 University of Ottawa Heart Institutehttp://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/ . Last reviewed November 2007 by J. Peter Oettgen, MDPlease 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.