Heart transplant

A heart transplant is surgery to remove a damaged or diseased heart and replace it with a healthy donor heart.

Description

Finding a donor heart can be difficult. The heart must be donated by someone who is brain-dead but is still on life support. The donor heart must be in normal condition without disease and must be matched as closely as possible to your blood and tissue type to reduce the chance that your body will reject it.

For this surgery, you are put into a deep sleep with general anesthesia, and a cut is made through the breastbone.

• Your blood flows through a heart-lung bypass machine while the surgeon works on your heart. This machine does the work of your heart and lungs while they are stopped, and supplies your body with blood and oxygen.
• Your diseased heart is removed and the donor heart is stitched in place. The heart-lung machine is then disconnected. Blood flows through the transplanted heart, which takes over supplying your body with blood and oxygen.
• Tubes are inserted to drain air, fluid, and blood out of the chest for several days, and to allow the lungs to fully re-expand.

Why the Procedure Is Performed

A heart transplant may be done to treat:

• Severe heart damage after a heart attack
• Severe heart failure, when medicines, other treatments, and surgery no longer help

  Heart failure

  Heart failure is a condition in which the heart is no longer able to pump oxygen-rich blood to the rest of the body efficiently. This causes symptom...

  

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• Severe heart defects that were present at birth and can't be fixed with surgery
• Life-threatening abnormal heartbeats or rhythms that do not respond to other treatments

Heart transplant surgery may not be used in people who:

• Are malnourished

  Malnourished

  Malnutrition is the condition that occurs when your body does not get enough nutrients.

  

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• Are older than age 65 to 70
• Have had a severe stroke or dementia

  Dementia

  Dementia is a loss of brain function that occurs with certain diseases. It affects one or more brain functions such as memory, thinking, language, j...

  

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• Have had cancer within the past 2 years
• Have HIV infection
• Have infections, such as hepatitis, that are active

  Hepatitis

  Hepatitis is swelling and inflammation of the liver.

  

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• Have insulin-dependent diabetes and other organs, such as the kidneys, that aren't working correctly

  Insulin-dependent diabetes

  Type 1 diabetes is a lifelong (chronic) disease in which there is a high level of sugar (glucose) in the blood.

  

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• Have kidney, lung, nerve, or liver disease

  Liver disease

  The term "liver disease" applies to many conditions that stop the liver from working or prevent it from functioning well. Abdominal pain or swelling...

  

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• Have no family support and do not follow their treatment
• Have other diseases that affect the blood vessels of the neck and leg
• Have pulmonary hypertension (thickening of blood vessels in the lung)

  Pulmonary hypertension

  Pulmonary hypertension is high blood pressure in the pulmonary arteries of the lungs. It makes the right side of the heart work harder than normal....

  

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• Smoke or abuse alcohol or drugs, or have other lifestyle habits that may damage the new heart
• Are not reliable enough to take their medicines, or if the person is not able to keep up with the many hospital and medical office visits and tests

Risks

Risks from any anesthesia are:

• Reactions to medicines
• Problems breathing

Risks from any surgery are:

• Bleeding
• Infection

Risks of transplant include:

• Blood clots (deep venous thrombosis)

  Deep venous thrombosis

  Deep vein thrombosis (DVT) is a condition that occurs when a blood clot forms in a vein deep inside a part of the body. DVT mainly affects the large...

  

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• Damage to the kidneys, liver, or other organs from anti-rejection medicines
• Development of cancer from the medicines used to prevent rejection
• Heart attack or stroke
• Heart rhythm problems
• High cholesterol levels, diabetes, and bone thinning from the use of rejection medicines
• Increased risk for infections due to anti-rejection medicines
• Lung and kidney failure
• Rejection of the heart
• Severe coronary artery disease

  Coronary artery disease

  Coronary heart disease is a narrowing of the blood vessels that supply blood and oxygen to the heart. Coronary heart disease (CHD) is also called co...

  

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• Wound infections
• The new heart may not work at all

Before the Procedure

Once you are referred to a transplant center, you will be evaluated by the transplant team. They will want to make sure that you are a good candidate for a transplant. You will visit many times over several weeks or even months. You will need to have blood drawn and x-rays taken. The following may also be done:

• Blood or skin tests to check for infections
• Tests of your kidney and liver
• Tests to evaluate your heart, such as ECG, echocardiogram, and cardiac catheterization

  ECG

  An electrocardiogram (ECG) is a test that records the electrical activity of the heart.

  

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  Echocardiogram

  An echocardiogram is a test that uses sound waves to create pictures of the heart. The picture and information it produces is more detailed than a s...

  

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  Cardiac catheterization

  Cardiac catheterization involves passing a thin flexible tube (catheter) into the right or left side of the heart. The catheter is most often insert...

  

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• Tests to look for cancer
• Tissue and blood typing, to help make sure your body will not reject the donated heart

  Tissue and blood typing

  A histocompatibility antigen blood test looks at proteins called human leukocyte antigens (HLAs). These are found on the surface of almost all cells...

  

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• Ultrasound of your neck and legs

You will want to look at one or more transplant centers to see which would be best for you:

• Ask them how many transplants they perform every year and what their survival rates are. Compare these numbers with the numbers from other centers. These are all available on the internet at unos.org.
• Ask what support groups they have available and how much help they offer with travel and housing.
• Ask about the costs of medicines you will need to take afterwards and if there is any financial help in getting the medicines.

If the transplant team believes you are a good candidate, you will be put on a regional waiting list for a heart:

• Your place on the list is based on several factors. Key factors include the type and severity of your heart disease, and how sick you are at the time you are listed.
• The amount of time you spend on a waiting list is usually NOT a factor for how soon you get a heart, except in the case of children.

Most, but not all, people who are waiting for a heart transplant are very ill and need to be in the hospital. Many will need some sort of device to help their heart pump enough blood to the body. Most often, this is a ventricular assist device (VAD).

Ventricular assist device

Ventricular assist devices (VADs) help your heart pump blood from one of the main pumping chambers to the rest of your body or to the other side of t...

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After the Procedure

You should expect to stay in the hospital for 7 to 21 days after a heart transplant. The first 24 to 48 hours will likely be in the intensive care unit (ICU). During the first few days after a transplant, you will need close follow-up to make sure that you do not get an infection and your heart is working well.

The recovery period is about 3 months and often, your transplant team will ask you to stay fairly close to the hospital during that time period. You will need to have regular check-ups with blood tests, x-rays, and echocardiograms for many years.

Fighting rejection is an ongoing process. The body's immune system considers the transplanted organ a foreign body and fights it. For this reason, organ transplant patients must take medicines that suppress the body's immune response. To prevent rejection, it is very important to take these medicines and carefully follow your self-care instructions.

Immune response

The immune response is how your body recognizes and defends itself against bacteria, viruses, and substances that appear foreign and harmful....

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Biopsies of the heart muscle are often done every month during the first 6 to 12 months after transplant, and then less often after that. This helps determine if your body is rejecting the new heart, even before you have symptoms.

You must take medicines that prevent transplant rejection for the rest of your life. You will need to understand how to take these medicines, and know their side effects.

You can go back to your normal activities 3 months after the transplant as soon as you feel well enough, and after talking with your health care provider. Consult your provider if you plan to engage in vigorous physical activity.

If you develop coronary disease after a transplant, you may have cardiac catheterization every year.

Outlook (Prognosis)

Heart transplant prolongs the life of people who would otherwise die. About 90% of heart transplant patients are alive 2 years after the operation. At 5 years, 75% of patients will still be alive after a heart transplant.

The main problem, as with other transplants, is rejection. If rejection can be controlled, survival increases to over 10 years.