Heart Transplant

WHAT YOU SHOULD KNOW:

• A heart transplant is a surgery done to replace your failing heart with a donor heart. The donor is another person who has chosen to give their organs to others when they die. Your heart looks like an upside-down pear and is found in your chest between your lungs. Your heart is connected to large blood vessels such as the aorta and vena cava. Your heart has four chambers (spaces) including two upper atria and two lower ventricles. The chamber walls are muscle tissue that beat (tighten and relax) constantly. With each beat, blood, oxygen, and nutrients are pumped to other tissue and organs in your body.
  
  
• Conditions such as heart failure, coronary artery disease, or congenital (born with) heart disease weaken and damage your heart. A weak or damaged heart may not pump enough blood to the rest of your body. Tissue and other organs will not have enough oxygen and nutrients to function properly. Heart disease may be controlled for a long time with medicines and other treatments. If your heart failure becomes severe (very bad), you may need a heart transplant. When you are in need of a heart transplant, you will be placed on a transplant list. You may need to wait for a long period of time before a donor heart is found. When a donor heart is found and ready, you will be called to the hospital.
  
  
• During surgery, your caregiver will cut open your chest down to your heart. Your failing heart will be removed and the donor heart will be secured in its place. When your new heart is in place and beating, your caregiver will close your chest. You may be watched closely in the hospital for a few weeks after your surgery. With a heart transplant, your symptoms such as shortness of breath and chest pain may resolve. A heart transplant may improve your ability to function without tiring so easily. You may be able to begin doing activities you enjoy again.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

• When you have severe heart failure, you have an increased risk of dying before a donor heart is found. Medicines used during your surgery may cause an allergic response. During surgery, you may bleed more than expected, or get an infection. The stitches securing your new heart may swell. Medicines used after surgery may increase your risk for infection or slow your healing. Medicines may also cause fluid to build up inside your body. You may also have an increased risk for ulcers (open sores) and bleeding in your stomach. You may have a decreased level of electrolytes (body salts) which can cause confusion and decreased stomach movement. Loss of body salts may also damage your heart and be life-threatening.
  
  
• You may get a blood clot in your leg or arm. This can cause pain and swelling, and it can stop blood from flowing where it needs to go in your body. The blood clot can break loose and travel to your lungs or brain. A blood clot in your lungs can cause chest pain and trouble breathing. A blood clot in your brain can cause a stroke. These problems can be life-threatening.
  
  
• After your transplant, you are at an increased risk for diabetes, kidney problems, and high blood cholesterol (fat). You may have abnormal heartbeats, high blood pressure, and heart valve problems. You may also be at risk of getting coronary artery disease (CAD) after surgery. With CAD, the blood vessels to your heart narrow and may lead to a heart attack or failure. Your body may reject (not accept) your new heart, and cause the heart to fail. If your body rejects your new heart, you may need another transplant. If you choose not to have a heart transplant, your symptoms may worsen, and you may die. Talk to your caregiver if you have questions about your condition, surgery, medicine, or care.

WHILE YOU ARE HERE:

Before your surgery:

• Informed consent: A consent form is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.
  
  
• Heart monitor: This is also called an ECG or EKG. Sticky pads placed on your skin record your heart's electrical activity.
  
  
• Pulse oximeter: A pulse oximeter is a device that measures the amount of oxygen in your blood. A cord with a clip or sticky strip is placed on your finger, ear, or toe. The other end of the cord is hooked to a machine. Never turn the pulse oximeter or alarm off. An alarm will sound if your oxygen level is low or cannot be read.
  
  
• IV: An IV is a tube that is placed in your vein for giving liquids and medicines.
  
  
• Pre-op care: You may be given medicine right before your surgery. This medicine may make you feel relaxed and sleepy. You are taken on a stretcher to the room where your procedure or surgery will be done. You will then be moved to a table or bed.
  
  
• General anesthesia: This is medicine that may be given in your IV or as a gas that you breathe. You may have a tube placed in your mouth and throat. This tube is called an endotracheal (ET) tube. Usually, you are asleep before your caregiver puts the tube into your throat. You will be completely asleep and free from pain during surgery.
  
  
• Antibiotics: This medicine is given to help treat or prevent an infection caused by bacteria.
  
  
• Arterial line: This is a tube placed into an artery (blood vessel), usually in your wrist or groin. The groin is the area where your abdomen meets your upper leg. An arterial line measures your blood pressure and may be used for taking blood.
  
  
• Swan-Ganz catheter: This is a thin tube put in a vein near your collarbone, or in your neck or groin. The tube goes into your heart and through to a blood vessel in your lungs. A Swan-Ganz can monitor the fluid in your blood vessels. The pressure in you heart and lungs may also be monitored. The catheter may also be used to give medicines or IV fluids.
  
  
• Foley catheter: A Foley catheter is a tube that is put into your bladder to drain your urine into a bag.
  
  
• Nasogastric tube: A nasogastric tube is put into your nose and down into your stomach. The tube may be attached to suction (vacuum) to keep your stomach empty.

During your surgery:

• A large incision (cut) is made down the middle of your chest. Your sternum (breastbone) is cut using special tools so caregivers can see your heart. Large blood vessels from your heart will be connected to a bypass machine. A bypass machine keeps oxygenated blood pumping through your body during your surgery. Your caregiver may do a biatrial heart transplant. To remove your heart, your caregiver will make a cut through your right and left atrium. He may leave a small part of both your atria to connect to the donor heart. Your aorta and an area of your vena cava may also be cut and connected to the donor heart. Your caregiver will then use stitches to attach the atria and blood vessels of the donor heart to your remaining heart tissue.
  
  
• Your caregiver may also choose to do a bicaval heart transplant. Your caregiver will remove your heart by cutting through your vena cava above and below your heart. Your caregiver will also cut through your aorta. A piece of your right atria will be left for attaching the donor heart. The large vessels of the donor heart will be attached to your aorta and upper and lower vena cava using stitches. The donor heart will also be connected to your remaining right atria.
  
  
• Steroid medicine may be given as a shot to prevent swelling during and after surgery. Temporary pacing wires may be attached to the chambers of your new heart using stitches. Pacing wires connect to a pacemaker to keep your heartbeats normal. Once the donor heart is secured, you will be removed from the bypass machine. Your new heart may start beating when blood flows through it. Drains may be placed in your chest to remove extra blood and fluid after your surgery. When your caregiver sees that your new heart is functioning without problems, your sternum will be closed with wires. Your chest incision is closed with stitches or staples and covered with a bandage. The bandage will keep your surgery site (wound) clean and dry to help prevent infection.

After your surgery:

You will be taken to a room where you will rest and be monitored. You may be given medicine to keep you asleep and comfortable for a period of time after surgery. You will have an endotracheal (ET) tube in your mouth and throat. The ET tube is hooked to a machine called a ventilator that helps you breathe. The ET tube will not be removed until you can breathe well on your own. When you are fully awake you may still have many tubes in place. The tubes may make it hard for you to move, but are needed to watch your condition. Do not get out of bed until a caregiver says it is OK and is there to help you. Caregivers will check your wound often for healing and any problems. The following may also be needed after your surgery:

• Vital signs: This includes taking your temperature, blood pressure, pulse (counting your heartbeat), and respirations (counting your breaths).
  
  
• Blood tests: You may need blood taken for tests. The blood can be taken from a blood vessel in your hand, arm, or the bend in your elbow. It is tested to see how your body is doing. You may need to have blood drawn more than once. Caregivers will monitor your blood sugar closely before, during, and after surgery. This will help decrease your chance of getting an infection. You may also need an arterial blood gas or ABG test. Blood is taken from an artery in your wrist, arm, or groin. Your blood is tested for the amount of "gases" in it, such as oxygen, acids, and carbon dioxide.
  
  
• Blood transfusion: You may need a blood transfusion if you lose a large amount of blood during surgery.
  
  
• IV fluids: You may need extra fluids in your body after your heart transplant. The fluids are given through the IV in your vein. IV fluids are liquid solutions that contain water, sugars, and proteins. They may also have electrolytes (body salts) in them needed to prevent abnormal heartbeats after surgery.
  
  
• Intake and output: Your caregivers may need to know the amount of liquid you are getting. They may also need to know how much you are urinating.
  
  
• Oxygen: You may need extra oxygen to help you breathe easier once your ET tube is removed. Oxygen may be given through a plastic mask over your mouth and nose. It may be given through a nasal cannula, or prongs, instead of a mask. A nasal cannula is a pair of short, thin tubes that rest just inside your nose.
  
  
• Nitrous oxide: Nitrous oxide may be needed to open your airways and help you breathe better. Nitrous oxide comes in the form of a gas that you breathe in.
  
  
• Photopheresis: During photopheresis, a machine is used to treat samples of your blood with ultraviolet (UV) light. This is done to remove cells that may cause your body to reject the donor heart. The treated blood will be returned to your body through an IV.

Medicines:

You may be given the following medicines:

• Antimicrobial medicines: Antibiotics may be given to help treat or prevent an infection caused by germs called bacteria. Antifungal medicine may be needed to help kill fungus that can cause infection and illness.
  
  
• Antirejection medicine: Your body may try to attack your new organ like it would attack an infection. These medicines are given to help your body accept your new organ and keep your body from rejecting it. You may need to take this medicine for the rest of your life.
  
  
  • Antihistamines: Antihistamines may be given before your antirejection medicines to prevent an allergic response.
    
    
  
  
• Diuretics: This medicine is given to decrease edema (excess fluid) that collects in a part of your body, such as your legs. Diuretics can also remove excess fluid from around your heart or lungs and decrease your blood pressure. It is often called water pills. You may urinate more often when you take this medicine.
  
  
• Heart medicines: You may need different medicines to control your heartbeat and blood pressure.
  
  
• Insulin: Insulin may be given to decrease the amount of sugar in your blood. Insulin helps your body move the sugar to your cells, where it is needed for energy.
  
  
• Pain medicines: Your caregiver may give you medicine to decrease your pain. Tell your caregiver if your pain does not get better after taking your medicine. Do not wait to ask for your pain medicine until the pain is very bad. The medicine may not work as well at controlling your pain if you wait too long to take it.
  
  
• Sedative: This medicine is given to help you stay calm and relaxed.
  
  
• Statins: These medicines are used to decrease the amount of fat in your blood.

Deep breathing and coughing:

Deep breathing and coughing helps keep you from getting a lung infection after surgery. Deep breathing opens the airways going to your lungs. Coughing helps to bring up sputum (mucus) from your lungs for you to spit out. Once your ET tube is removed, you should breathe deeply and cough every hour while you are awake.

• Hold a pillow tightly against your wound when you cough to help decrease the pain. Take a deep breath and hold the breath as long as you can. Then push the air out of your lungs with a deep, strong cough. Put any sputum that you have coughed up into a tissue. Take 10 deep breaths in a row every hour while you are awake. Remember to follow each deep breath with a cough.
  
  
• You may be asked to use an incentive spirometer. This helps you take deeper breaths. Put the plastic piece into your mouth and take a very deep breath. Hold your breath as long as you can. Then let out your breath. Use your spirometer every hour while you are awake. When you are asleep, caregivers may need to wake you up every 2 to 4 hours to use your spirometer.

Diet:

Once you are breathing on your own and bowel sounds are heard, you may be able to eat. Your caregiver will listen to your stomach for bowel sounds using a stethoscope. You may be given ice chips at first, and then liquids such as water, broth, or juice. When you are able to drink the liquids without problems, caregivers may then give you soft foods. Some examples of soft foods are ice cream, applesauce, or custard. Once you can eat soft food easily, you may begin eating your usual diet.

Foley catheter:

This is a tube caregivers put into your bladder to drain your urine into a bag. Keep the bag below your waist. This will help prevent infection and other problems caused by urine flowing back into your bladder. Do not pull on the catheter, because this may cause pain and bleeding, and the catheter could come out. Keep the catheter tubing free of kinks so your urine will flow into the bag. Caregivers will remove the catheter as soon as possible, to help prevent infection.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

Learn more about Heart Transplant (Inpatient Care)