What is heart transplant surgery?
Heart transplant surgery is the removal of a failing heart and pre-existing hardware (such as an implantable cardio defibrillator or pacemakers) and its replacement by a donor heart.
Why is it done?
Heart transplant is used to treat severe, end-stage heart failure. This heart failure may be the result of damage to the heart from:
- Coronary artery disease, such as a heart attack.
- Severe, untreated hypertension (hypertensive heart disease).
- Heart valve problems.
- Infections, such as viruses.
- Alcohol and illicit drug use.
- Inherited heart disease.
- Congenital heart disease (a malformation of the heart a person is born with).
- Unknown (idiopathic).
For severely ill patients, a mechanical heart (mechanical assist device) may be used temporarily while waiting for a donor heart.
What is done?
During the operation:
- A bypass machine will be used to pump blood to the rest of your body.
- Most of the old, failing heart will be removed.
- The posterior walls of both upper chambers (atria) are left in place and the new heart is attached to this remaining tissue.
- The blood vessels leading in and out of the heart are also attached to the new heart. (As a precaution, pacing wires may be placed on the surface of the heart, which can be connected to an external pacemaker, if necessary. Prior to discharge, these wires will be removed.)
- The new heart is then shocked so it will start beating and the chest is closed.
What can you expect?
Before the operation
Once it is determined that you require a new heart, you will be evaluated to determine whether you are a good candidate for heart transplant. If you are, your name will be put on the heart transplant waiting list.
- Your position on the list will depend upon how ill you are, and may be moved up over time if your health changes.
- Once on the waiting list, you will receive a pager so you can be contacted immediately when a suitable heart becomes available.
- Since the donor heart has to be transplanted within hours of donation, you may want to stay prepared by making a travel plan ahead and packing a suitcase with your medication for a hospital stay.
Preparation for surgery includes:
- blood work
- an electrocardiogram (ECG)
- a chest X-ray
- a urine sample
- an intravenous line for measuring pressure in the lung arteries.
During the operation
A transplant is conducted under a general anesthetic so you will be asleep throughout the procedure. Once you are sedated, the surgeons will place:
- a tube down your windpipe, which will be connected to a breathing machine called a respirator to support your breathing during the surgery.
- a tube into your stomach to stop liquid and air from collecting in your stomach so you will not feel sick and bloated when you wake up.
- a tube into your bladder to collect urine.
The surgery usually takes about 3 to 5 hours, but it can vary.
After the operation
When you awaken, you will be in the intensive care unit (ICU) or cardiovascular intensive care unit (CVICU).
- Once you are awake and able to breathe adequately, you will be detached from the ventilator and the tube down your windpipe will be removed.
- Pain medication will be given to you, either intravenously or as pills.
- As you recover, you will be transferred to a step-down unit and then to a regular room.
- You can expect to stay in the hospital at least two to three weeks after surgery.
- Drugs to suppress your immune system (immunosuppressive therapy) will be administered to prevent your body from rejecting the donor heart. A rehabilitation program will be designed to help your recovery.
At home
Upon returning home, you should watch for possible signs of infection, such as:
- fever
- sore throat
- shortness of breath
- coughing
- cold sores
- flu-like symptoms or feeling unwell
- redness, swelling or drainage from your incision.
Possible signs of rejection of the donor heart include:
- shortness of breath
- weight gain
- fever
- fatigue.
Most patients continue to receive follow-up care for several months after they return home.
