Heart transplant surgery

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.