Heart Transplant

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 examEchocardiogram a test that uses high-frequency sound waves (ultrasound) to examine the size, shape, and motion of the heart Tissue typingIdentify 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 ProcedureIV fluidsOxygenAnesthesiaDiversion of 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 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 monitorPacing wires used to help control heart rateTubes connected to a machine that helps drain excess blood and airBreathing 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 ComplicationsInfectionRejection of the new heartCoronary 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 problems Infection or cancer related to taking immunosuppressive medications Death Average Hospital StayTwo weeks, if there are no signs of rejecting the new heart

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. OutcomeThe 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 OccursSigns 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 siteCough, shortness of breath, chest pain, or severe nausea or vomitingCoughing up bloodSudden headache or feeling faintSensation of your heart fluttering, missing beats, or beating erraticallyPain, burning, urgency, frequency of urination, or persistent bleeding in the urineExcessive tiredness, swelling of feetWaking up at night due to being short of breath 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.