Heart Transplant
Posted July 1, 2008 7:41 PM
Posted in
Definition
This is a surgical procedure to remove a severely diseased and failing heart and replace it with a healthy heart from a deceased donor.
Normal vs. Diseased Heart
© 2008 Nucleus Medical Art, Inc.
Reasons for Procedure
A heart transplant is done to treat irreversible, life-threatening heart diseases that cannot be managed using any other type of medical or surgical method. Transplant recipients are severely disabled by their heart condition but are otherwise in good health. The procedure is most often performed for the following reasons:
- Cardiomyopathy (disease of the heart muscle)
- Severe coronary artery disease unresponsive to other treatments
- Congenital heart defects
- Valvular defects leading to severe, unremitting congestive heart failure
Risk Factors for Complications During the Procedure
- Pre-existing heart condition
- Age: 60 or older
- Lung disease, including chronic obstructive pulmonary disease ( emphysema ) and pulmonary hypertension
- Poor circulation or other vascular disease
- Kidney or liver disease
- Smoking
- Presence of serious active infection, such as pneumonia and tuberculosis
- Treatment for cancer within the previous five years
- Debilitation and malnourished
- Uncontrolled diabetes
- Previous stroke or other damage to the blood vessels of the brain
- Mental illness or continued substance or alcohol abuse
- Autoimmune disease
- Potentially recurrent heart disease
What to Expect
Prior to Procedure
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 a donor heart becomes available.
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 exam
- Echocardiogram —a test that uses high-frequency sound waves (ultrasound) to examine the size, shape, and motion of the heart
- Tissue typing
- Identify 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 Procedure
- IV fluids
- Oxygen
- Anesthesia
- Diversion of circulation through a heart-lung machine
Anesthesia
Description of the Procedure
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 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 monitor
- Pacing wires used to help control heart rate
- Tubes connected to a machine that helps drain excess blood and air
- Breathing 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 Complications
- Infection
- Rejection of the new heart
- Coronary artery disease (half of all heart-transplant recipients develop coronary artery disease)
- Pneumonia
- Phlebitis (blood clots of a vein)
- Excessive bleeding
- Neurological deficits, stupor, coma , decreased intellectual function
- Kidney dysfunction
- Irregular heart rate
- Anesthesia-related problems
- Infection or cancer related to taking immunosuppressive medications
- Death
Average Hospital Stay
Two weeks, if there are no signs of rejecting the new heart
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.
Outcome
The 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 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
- 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
- Excessive tiredness, swelling of feet
- Waking up at night due to being short of breath
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/ .
Last reviewed November 2007 by J. Peter Oettgen, MD
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.
Copyright © 2007 EBSCO Publishing All rights reserved.
Source: EBSCO
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