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WHAT YOU NEED TO KNOW:
A heart transplant is surgery to replace your heart with a healthy, donor heart.
HOW TO PREPARE:
Before your surgery:
While you wait for your donor heart:
- Before your transplant, you may need to do advanced care planning with your healthcare provider. You will need to let your healthcare provider know you have support from family and friends. You and your healthcare provider may talk about the life changes you need to make after your surgery. Talk to your healthcare provider if you feel you or your supports will not be able to manage your care. Talk to your healthcare provider about any concerns you have.
- Continue taking the heart medicines your healthcare provider has ordered for you. Your healthcare provider may also order 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 healthcare provider for more information about the medicines you need while you wait for your transplant.
- You may need to decrease the amount of liquid you drink before your surgery. Your healthcare provider may also have you weigh yourself daily. Your heart failure may cause fluid to build up in your body. Fluid buildup increases your risk for edema (tissue swelling). Fluid may also build up around your heart and lungs and cause shortness of breath. Your healthcare provider may order diuretics (water pills) to help your body get rid of the extra fluid. You may also need ultrafiltration, which uses a machine to remove extra fluid from your body.
- If you are in the hospital while you wait for your donor heart, you may need a heart catheter (tube). A heart catheter allows your healthcare providers 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 healthcare provider 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 have sleep apnea, a condition that can affect your heart. You may need blood and urine tests. You may also need an electrocardiogram, echocardiogram, cardiac catheterization, or stress tests. Chest x-rays, ultrasound, a CT scan, or MRI may also be done. If you are female, a mammography or mammogram test may also be needed Your healthcare provider may also want you to visit a dentist for an exam before your surgery. These tests help healthcare providers be sure you are healthy enough for this surgery. Ask your healthcare provider for more information about these and other tests you may need. Write down the date, time, and location of each test.
- Write down the correct date, time, and location of your surgery.
- Arrange for someone to drive you home from the hospital. Do not drive yourself home.
- Bring your medicine bottles or a list of your medicines when you see your healthcare provider. Tell your provider if you are allergic to any medicine. Tell your provider if you use any herbs, food supplements, or over-the-counter medicine.
- Ask your healthcare provider if you need to stop using aspirin or any other prescribed or over-the-counter medicine before your procedure or surgery.
- 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 healthcare provider for more information about blood transfusions.
The day of your surgery:
- You or a close family member will be asked to sign a legal document called a consent form. It gives healthcare providers permission to do the procedure or surgery. It also explains the problems that may happen, and your choices. Make sure all your questions are answered before you sign this form.
- What to bring: You may want to bring items such as a toothbrush and bathrobe.
- IV: An IV is a tube that is placed in your vein for giving liquids and medicines.
- 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.
- An anesthesiologist will talk to you before your surgery. You may need medicine to keep you asleep or numb an area of your body during surgery. Tell healthcare providers if you or anyone in your family has had a problem with anesthesia in the past.
WHAT WILL HAPPEN:
What will happen:
- 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 healthcare providers 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 healthcare provider may make a cut through your right and left atria to remove your heart. 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 healthcare provider will then use stitches to attach the atria and blood vessels of the donor heart to your remaining heart tissue.
- Your healthcare provider may also choose to do a bicaval heart transplant. Your healthcare provider will remove your heart by cutting through your vena cava above and below your heart. Your healthcare provider 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 healthcare provider 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. A healthcare provider 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 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 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 for healing and any problems. Healthcare providers will also give you pain medicine.
CONTACT YOUR HEALTHCARE PROVIDER IF:
- You get sick with a cold or the flu.
- You have a fever.
- You feel depressed.
- You feel weaker than what is normal for you.
- One or both of your ankles are swollen.
Seek Care Immediately if
- You feel 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 gray.
- You have pain or tenderness in the upper part of your abdomen.
- Your skin or eyes have a yellowish color.
- Call 911 or an ambulance if you have any signs of a heart attack:
- Discomfort in the center of your chest that feels like squeezing, pressure, fullness, or pain, that lasts for more than a few minutes or keeps returning
- Discomfort or pain in your back, neck, jaw, stomach, or one or both of your arms
- Feeling sick to your stomach
- Having trouble breathing
- A sudden cold sweat, particularly in combination with chest discomfort or trouble breathing
- Feeling very lightheaded or dizzy, particularly in combination with chest discomfort or trouble breathing
- 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.
Care AgreementYou 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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