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Heart Transplant

WHAT YOU NEED TO KNOW:

A heart transplant is surgery to replace a damaged heart with a new heart from another person.

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.
  • Medicines may be given to help prevent infection or help prevent your body from rejecting your new heart.
  • An arterial line is a tube that is placed into an artery (blood vessel), usually in the wrist or groin. An arterial line may be used for measuring your blood pressure or for taking blood.
  • A Swan-Ganz catheter 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.

During your surgery:

  • You will receive anesthesia to keep you asleep and free from pain during your surgery. A large incision will be made down the middle of your chest. Your sternum (breastbone) will be cut so your surgeon 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 surgeon may make a cut through your right and left atria to remove your heart. He or she 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 surgeon will then use stitches to attach the atria and blood vessels of the donor heart to your remaining heart tissue.
  • Your surgeon may also choose to do a bicaval heart transplant. He or she will remove your heart by cutting through your vena cava above and below your heart. He or she 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 with 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 surgeon 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 the recovery room or an intensive care unit (ICU). Healthcare providers will monitor you closely. 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 monitor your condition. Do not get out of bed until a healthcare provider says it is okay and is there to help you. Healthcare providers will check your wound often. You may also need any of the following:

  • 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.
  • Take deep breaths and cough 10 times each hour. This will decrease your risk for a lung infection. Take a deep breath and hold it for as long as you can. Let the air out and then cough strongly. Deep breaths help open your airway. You may be given an incentive spirometer to help you take deep breaths. Put the plastic piece in your mouth and take a slow, deep breath, then let the air out and cough. Repeat these steps 10 times every hour.
  • 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.
  • You will be able to drink liquids and eat certain foods once your stomach function returns after surgery. You may be given ice chips at first. Then you will get liquids such as water, broth, juice, and clear soft drinks. If your stomach does not become upset, you may then be given soft foods, such as ice cream and applesauce. Once you can eat soft foods easily, you may slowly begin to eat solid foods.
  • Blood tests will be needed to check your organ functions and oxygen levels.
  • A blood transfusion may be needed if you lost a large amount of blood during surgery.
  • 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:
    • Prescription pain medicine will be given to decrease pain. Do not wait until the pain is severe before you ask for more medicine.
    • A sedative may be needed to help you stay calm and relaxed.
    • Heart medicines may be needed to control your heart rate and blood pressure.
    • Antibiotics help prevent a bacterial infection.
    • Antirejection medicine helps prevent your body from rejecting your new heart.
    • Diuretics help remove extra fluid that collects in your body. These are often called water pills.

RISKS:

  • You may bleed more than expected or get an infection. Nerves, blood vessels, muscles, and other organs may get damaged. You may develop a life-threatening blood clot in your arm or leg. Your condition may get worse during surgery, and may become life-threatening. Your body may reject the new heart.
  • 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.

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 healthcare providers to decide what care you want to receive. You always have the right to refuse treatment.

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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.

Further information

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