Heart Transplant

WHAT YOU SHOULD KNOW:

A heart transplant is surgery to replace your heart with a healthy, donor heart.

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:

  • During surgery, you may bleed more than expected, or get an infection. You may also have an increased risk for ulcers and bleeding in your stomach. You may have a decreased level of electrolytes, which can cause confusion and decreased digestion in your stomach. Loss of body salts may also damage your heart and be life-threatening. You may get a blood clot in your arm or leg. The clot may travel to your heart or brain and cause life-threatening problems, such as a heart attack or stroke.

  • After your transplant, you are at an increased risk for diabetes, kidney problems, and high cholesterol. You may have abnormal heartbeats, high blood pressure, and heart valve problems. You may also be at risk for coronary artery disease (CAD) after surgery. CAD may cause the blood vessels to your heart to narrow and may lead to a heart attack or heart failure. Your body may reject 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 become life-threatening.

WHILE YOU ARE HERE:

Before your surgery:

  • Informed consent 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.

  • An IV is a small tube placed in your vein that is used to give you medicine or liquids.

  • General anesthesia will keep you asleep and free from pain during surgery. Anesthesia may be given through your IV. You may instead breathe it in through a mask or a tube placed down your throat. The tube may cause you to have a sore throat when you wake up.

  • Antirejection medicine: These help prevent your body from rejecting your new heart. You may need to take this medicine for the rest of your life.

  • Antibiotics: This medicine is given to help treat or prevent an infection caused by bacteria.

  • Monitoring:

    • 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.

    • Arterial line: An arterial line is a tube that is placed into an artery (blood vessel), usually in the wrist or groin. The groin is the area where your abdomen meets your upper leg. An arterial line may be used for measuring your blood pressure or 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 your 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 to keep your stomach empty.

During your surgery:

  • A large incision will be made down the middle of your chest. Your sternum (breastbone) will be cut so caregivers can see your heart. Large blood vessels from your heart will be connected to a bypass machine to keep blood pumping during your surgery. Your caregiver may do a biatrial heart transplant. This means he will make a cut through your right and left atria. 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 choose to do a bicaval heart transplant. During this surgery, your caregiver will remove your heart by cutting through your vena cava above and below your heart. He will also cut through your aorta. A piece of your right atrium 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 atrium.

  • 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 with 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 will be closed with stitches or staples and covered with a bandage. The bandage will keep your 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. Caregivers will monitor your heart rate, blood pressure, breathing, and temperature closely. 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 be removed when 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 okay 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:

  • Blood tests: You will need to have blood tests after surgery to check how your body is doing. You also will need to have arterial blood gas (ABG) tests to measure oxygen, acids, and carbon dioxide levels.

  • 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, sugar, and protein. They may also have electrolytes 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.

  • You may need extra oxygen if your blood oxygen level is lower than it should be. You may get oxygen through a mask placed over your nose and mouth or through small tubes placed in your nostrils. Ask your healthcare provider before you take off the mask or oxygen tubing.

  • 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: 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:

  • Antirejection medicine: These help prevent your body from rejecting your new heart. You may need to take this medicine for the rest of your life.

  • 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 medicines to control your heartbeat and blood pressure.

  • Pain medicine: You may be given a prescription medicine to decrease pain. Do not wait until the pain is severe before you ask for more medicine.

  • Sedative: This medicine is given to help you stay calm and relaxed.

  • Cholesterol medicine: These decrease the amount of cholesterol in your blood.

  • Antimicrobial medicines: These prevent a bacterial or fungal infection.

A Foley catheter

is a tube put into your bladder to drain urine into a bag. Keep the bag below your waist. This will prevent urine from flowing back into your bladder and causing an infection or other problems. Also, keep the tube free of kinks so the urine will drain properly. Do not pull on the catheter. This can cause pain and bleeding, and may cause the catheter to come out. Caregivers will remove the catheter as soon as possible to help prevent infection.

Deep breathing and coughing:

This will help decrease your risk for a lung infection after surgery.

  • Hold a pillow tightly against your incision when you cough to help decrease pain. Take a deep breath and hold it for as long as you can. Deep breaths help open your airways. Let the air out and follow with a strong cough. Spit out any mucus you cough up. Repeat the steps 10 times every hour.

  • You may be given an incentive spirometer to help you take deep breaths. Put the plastic piece into your mouth and take a slow, deep breath. Let out your breath and cough. Repeat the steps 10 times every hour.

Nutrition:

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 with 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. Once you can eat soft food easily, you may begin eating normally.

© 2014 Truven Health Analytics Inc. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes. All illustrations and images included in CareNotes® are the copyrighted property of A.D.A.M., Inc. or Truven Health Analytics.

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)

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