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 arterial 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. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. 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. Surgery may cause an infection, trouble breathing, blood clots, and you may die. 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 increase 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.
  
  
• 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 arterial 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.

GETTING READY:

Before your surgery:

• While waiting for your donor heart:
  
  
  • Before your transplant, you may need to do advanced care planning with your caregiver. You will need to let your caregiver know if you have enough support from family and friends. You and your caregiver may talk about the life changes you need to make after your surgery. Talk to your caregiver if you do not feel you or your supports will be able to manage your care. Talk to your caregiver about any concerns you have while you wait for your donor heart.
    
    
  • Continue taking the heart medicines your caregiver has ordered for you. Your caregiver may also order other medicines for you to take while waiting for your transplant. You may need medicines to keep your blood pressure normal and prevent abnormal heartbeats. You may need anticoagulant medicine if you are at risk for blood clots . Ask your caregiver for more information about the medicines you need while waiting for your transplant.
    
    
  • You may need to decrease the amount of liquid you drink before your surgery. Your caregiver may also have you weigh yourself daily. Your heart failure may cause fluid to build up in your body. With increased fluid you are at risk for edema (tissue swelling). Fluid may also build up around your heart and lungs and cause shortness of breath. Your caregiver may order diuretics (water pills) for you to help your body get rid of the extra fluid. You may also need ultrafiltration while waiting for your donor heart. Ultrafiltration is a procedure done using a special machine to remove extra fluid from your body.
    
    
  • If you are in the hospital while waiting for your donor heart, you may need a heart catheter (tube). A heart catheter allows your caregivers to monitor your heart condition.
    
    
  • You may need devices such as a heart defibrillator or a pacemaker before your surgery. These devices may help your heart beat normally so it can pump blood to other parts of your body. Ask your caregiver for more information about these devices and why you might need them.
    
    
  • You may need to have a sleep study test. A sleep study may show if you are at risk for problems during and after your surgery. You may need different blood and urine tests. You may also need an electrocardiogram, echocardiogram, cardiac catheterization, or stress tests. Chest x-rays, ultrasound, a computerized tomography scan, and magnetic resonance imaging may also be done. If you are female, a mammography or mammogram test may also be needed. Your caregiver may also want you to visit a dentist for an exam before your surgery. Ask your caregiver for more information about these and other tests you may need. Write down the date, time, and location of each test.
  
  
• Getting ready for surgery:
  
  
  • Ask someone to drive you home when you are ready to leave the hospital. Do not drive yourself home.
    
    
  • Bring your medicine bottles or a list of your medicines when you see your caregiver. Tell your caregiver if you are allergic to any medicine. Tell your caregiver if you use any herbs, food supplements, or over-the-counter medicine.
    
    
  • You may need a blood transfusion if you lose a large amount of blood during surgery. You may ask a family member or friend with the same blood type to donate (give) blood for you. Ask your caregiver for more information about blood transfusions.
    
    
  • If you have diabetes (increased blood sugar), you may be at higher risk for problems after surgery. Ask your caregiver for instructions about what you should eat and drink before your surgery. If you use medicine to treat diabetes, your caregiver may also have instructions about using them before surgery.

The day of your surgery:

• What to bring: You may want to bring items such as a toothbrush and bathrobe.
  
  
• You or a close family member will be asked to sign a legal piece of paper (consent form). It gives your caregiver permission to do the procedure or surgery. It also explains the problems that may happen, and your choices. Be sure all your questions have been answered before you sign this form.
  
  
• IV: An IV is a tube that is placed in your vein for giving liquids and medicines.
  
  
• 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 (stomach) 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.
  
  
• An anesthesiologist may talk to you before your surgery. This caregiver may give you medicine to make you sleepy before your procedure or surgery. Tell your caregiver if you or anyone in your family has had a problem using anesthesia in the past.

TREATMENT:

What will happen:

• General anesthesia will be given to keep you completely asleep 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. A caregiver will check your blood pressure, breathing, heart rate, and temperature often after your surgery. 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. Caregivers will also work with you to keep your pain controlled.

CONTACT A CAREGIVER IF:

• One or both of your ankles are swollen.
  
  
• You feel weaker than what is normal for you.
  
  
• You feel depressed (deep sadness).
  
  
• You get sick (a cold or the flu).
  
  
• You have a fever (increased body temperature).

SEEK CARE IMMEDIATELY IF:

• You are feeling very tired and confused.
  
  
• You are urinating less than what is normal for you, or not at all.
  
  
• You feel cold and sweaty, and your hands and feet look blue or grayish in color.
  
  
• You have sudden chest pain or trouble breathing.
  
  
• You hear a high-pitched noise when you breathe.
  
  
• You feel anxious, dizzy, and your heart feels like it is beating faster than normal.
  
  
• You have pain or tenderness in the upper part of your abdomen (stomach).
  
  
• Your skin or eyes have a yellowish color.

Copyright © 2008 Thomson Healthcare Inc. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.

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.

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