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Heart Transplant
By Dr Pramod Reddy
Chief Cardiothoracic and Vascular Surgeon
Published on / 12 August 2022

 Overview| Procedure| Risks| Care at Medicover | Frequently Asked Questions

Overview

A heart transplant is a heart surgery that removes the diseased heart of an individual and replaces it with a healthy heart from an organ donor. Two or more doctors must declare the donor brain-dead before the heart can be removed.

Before you can be kept on a heart transplant waiting list, the doctor must determine that this is the best treatment option for your heart failure. A medical team and anaesthesiologist also ensures that you are otherwise healthy enough to undergo the transplant procedure.


Why is heart transplantation performed?

If the heart is failing and other treatments are ineffective, you may require a heart transplant. The following conditions account for the vast majority of reasons for heart transplantation:

  • Heart attack
  • A weakening of the heart muscle (cardiomyopathy)
  • Coronary artery disease with poor heart function
  • Heart valve disease with poor heart function and high lung pressure
  • Untreatable Congenital heart defect
  • Abnormal heart rhythms which are not controlled by other treatments.

Procedure

Before the Procedure

A cardiologist will discuss your options and answer any questions you may have. Additional physician visits and tests will be performed based on your medical history. The majority of evaluations include:

During the Procedure

Open heart surgery is conducted for a heart transplant and requires a hospital stay. Generally, a heart transplant surgery involves the following process:

  • An intravenous line is inserted into your arm to administer IV fluids. Catheters will be inserted into the neck and wrist blood vessels to monitor heart and blood pressure and collect blood samples.
  • A flexible tube will be put into the urinary bladder to drain urine.
  • A tube will be inserted into your stomach to drain gastric fluids through your mouth.
  • Your chest hair may be shaved if it is in excess. An antiseptic solution will be used to clean the skin on the chest.
  • The heart transplant surgery will be performed while you are unconscious and under general anaesthesia. Once you are under anaesthesia, a breathing tube will be inserted into your lungs through your mouth. The tube will be connected to a machine known as a ventilator, which will help to breathe during the procedure.
  • During the surgery, the anesthesiologist will monitor your vitals.
  • An incision will be made down the centre of your chest, from just below the neck to just above the abdomen.
  • The breastbone will be cut into half by the surgeon. They will split the breastbone in half to reach the heart.
  • The surgeon will insert tubes into the chest so a heart-lung machine can pump blood through your body while your heart is stopped.
  • The diseased heart will be removed when the blood is diverted completely into the bypass machine.
  • The donor heart will be secured in place by the surgeon. When the donor's heart is in place, the blood vessels will be carefully connected to ensure no leaks.
  • The blood circulating through the bypass machine will be allowed back into the heart when the donor's heart is fully connected, and the tubes connected to the heart-lung machine will be removed. To restart the heartbeat, the surgeon will give a shock to the heart with small paddles.
  • Once your new heart begins to beat, the surgeon and team will monitor it to ensure that it is functioning properly and that there are no leaks.
  • Pacing wires may be implanted in the heart. If necessary, your surgeon can connect these wires to an external pacemaker to pace your new heart during the initial recovery period.
  • The sternum will be approximated and sewn together with wires.
  • The skin over the sternum will be stitched back together. To close the incision, they will use sutures or surgical staples.
  • Tubes will be inserted into your chest to drain blood and fluids from the area surrounding your heart. As the heart heals, these tubes will be attached to a suction device that will drain fluids away from it.
  • A sterile bandage will be applied.

After the Procedure

  • You will be shifted to the intensive care unit (ICU) or the recovery room. A hospital stay of at least one to two weeks is required for heart transplant surgery.
  • A tube is placed in the throat that connects to a breathing machine (ventilator) until you are stable to breathe by yourself. As you recover and begin to breathe, the breathing machine will be removed. The breathing tube will be removed when you can breathe completely on your own and cough.
  • A nurse will assist you in coughing and taking deep breaths every 2 hours. This will be painful, but you must do it to prevent mucus from accumulating in the lungs causing pneumonia.
  • Pain medication is administered as needed.
  • To remove the air that you swallow, you may have a tube that goes through your nose and into the stomach.
  • Blood samples are taken to observe new heart and other body functions.
  • You may be given IV medications to help your blood pressure and heart and to control any bleeding problems. As your condition improves, the doctor will gradually reduce and discontinue these medications. Pacing wires in your heart will be removed.
  • When the breathing and stomach tubes are removed, and you are stable, you can begin to drink liquids. You can gradually introduce more solid foods as you are able.
  • The doctor team will closely monitor your immunosuppressant medications to ensure that you receive the correct dose and combination of medications.
  • As you initiate physical therapy and breathing exercises, you will be assisted by nurses, respiratory therapists, and physical therapists.
  • When the doctor determines that you are improving, you will be transferred from the ICU to a normal ward. You can gradually increase your activity level as you get out of bed and walk around for longer.
  • Doctors and team members will teach you how to care for yourself once you return home.
  • You are scheduled for a follow-up visit with the doctor.

Risks

Complications are possible with any surgery. Some of the potential risks of a heart transplant are:

  • Infection
  • Bleeding during or after the surgery
  • Coronary allograft vasculopathy (CAV): Blood vessels that carry oxygenated blood to the heart muscle are thickened and hardened.
  • Blood clots that can lead to a heart attack, stroke, or lung disease
  • Breathing problems
  • Kidney failure
  • Rejection of the donor's heart

Care at Medicover

Cardiothoracic surgeons at Medicover Hospitals are the most trusted team of doctors and medical experts with extensive experience providing excellent healthcare services to patients with compassionate care. Our diagnostic department is fully equipped with cutting-edge technology and equipment to perform the tests required for diagnosing cardiovascular diseases, upon which the most suitable and appropriate treatment plan is designed and carried out with utmost precision, resulting in successful treatment outcomes.

Frequently Asked Questions:

There are two types of heart transplants.They are:

Orthotopic heart transplants involve removing your diseased heart through an incision in the middle of your chest and replacing your old heart with a donor's heart.

Heterotopic heart transplants involve attaching the donor heart to your old heart.

Recovery takes about six to eight weeks for your incisions to heal. Initially, muscle or incision discomfort in the chest during activity is present. Itching, tightness, or numbness along your incision are also normal.

Avoid strenuous activities such as pushing, pulling or lifting anything heavy for at least 6 to 12 weeks.

You will usually need to stay in hospital for approximately two weeks after a heart transplant.

Avoid highly salted foods and high sodium processed foods after heart transplant.

A heart transplant is carried out under general anaesthetic and normally it takes between 4 and 6 hours.

The complications following heart transplantation are bleeding, infection, breathing problems, kidney failure, failure of the donor's heart, coronary allograft vasculopathy(CAV) and blood clots that can cause heart attack, stroke or lung problems.

The most common causes of death in the first 30 days after transplantation are graft failure, multi-organ failure, and infection, with infection, graft failure, and acute rejection being the most common causes of death within one year of transplant.

The rejection of the donor's heart is one of the most common complications of a heart transplant. The immune system recognises the transplanted heart as foreign and attacks it.

Infants and children who receive heart transplants have good outcomes and can expect to live for another 15 years with reasonable cardiac function and quality of life.


References:

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