Heart transplant

Definition

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

Alternative Names

Cardiac transplant; Transplant - heart

Description

Finding a donor heart can be difficult. The heart is donated by someone who has been declared brain-dead but remains on life support. The donor heart must be matched as closely as possible to your tissue type to reduce the chance that your body will reject the new heart.

The patient is put into a deep sleep with general anesthesia, and a cut is made through the breast bone.

• The patient's blood is circulated through a heart-lung bypass machine to keep the blood oxygen-rich during the surgery.
• The patient's diseased heart is removed and the donor heart is stitched in place. The heart-lung machine is disconnected. Blood flows through the transplanted heart.
• Tubes may be inserted to drain air, fluid, and blood out of the chest for several days, to allow the lungs to fully re-expand.

Why the Procedure is Performed

A heart transplant may be recommended for:

• Severe angina that can no longer be treated with medications or surgeries to repair the coronary arteries
• Severe heart failure, when medicines, other treatments, and surgery no longer help. Possible causes of severe heart failure are:
  • Coronary artery disease
  • Cardiomyopathy (disease of the heart muscle)
  • Heart valve disease with congestive heart failure
• Severe heart defects that were present at birth and cannot be fixed with surgery
• Life-threatening abnormal heart beats or rhythms that do not respond to other therapy

Heart transplant surgery may NOT be recommended for patients who have:

• Had cancer
• Infections such as hepatitis, that are considered to be active
• Insulin-dependent diabetes with poor function of other organs
• Kidney, lung, nerve, or liver disease
• Malnutrition
• Other diseases that affect the blood vessels of the neck and leg
• Smoking, alcohol or drug abuse, or other lifestyle habits that may damage the new heart

The doctor may also recommend against a heart transplant if there is concern that the patient will not be able to comply with the many hospital and doctor's office visits, tests, and medications needed to keep the new heart healthy.

Outlook (Prognosis)

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).

The recovery period is about 6 months. Often, your transplant team will ask you to stay fairly close to the hospital for the first 3 months. Patients need to have regular check-ups with blood test and x-ray for many years.

Fighting rejection is an ongoing process. The body's immune system considers the transplanted organ an infection and fights it. For this reason, organ transplant patients must take drugs that suppress the body's immune response. Taking medicines and following instructions precisely is very important to preventing rejection.

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

Risks

Risks for any anesthesia are:

• Reactions to medications
• Problems breathing

Risks for any surgery are:

• Bleeding
• Infection

Risks of transplant include:

• Blood clots (deep venous thrombosis)
• Damage to the kidneys, liver, or other body organs from anti-rejection (immunosuppression) medications
• Heart attack or stroke
• Heart rhythm problems
• Increased risk for infections due to anti-rejection (immunosuppression) medications
• Wound infections