Home Treatment & Recovery The Heart Transplant Procedure

The Heart Transplant Procedure

How do I prepare for the transplant procedure?

While waiting for a donor heart to become available, it is important that you continue taking all your heart failure medications and keep other health conditions under control. The healthier you are when you receive the transplant, the more quickly you will recover from the procedure and the better you will do with your new heart.

When a donor organ becomes available, you will need to be ready to go to the transplant center immediately (usually within 2 hours) if you are not already in the hospital. After the donor heart is removed and packed for transport, it must be implanted within 4 or 5 hours. A few things you can do to make sure you are prepared:

  • Be reachable: Your transplant team should be able to contact you at all times. They should have your cell phone and home phone numbers. Some transplant centers give you a special pager that will beep when a donor has been identified.
  • Plan a route: Know how you are going to get to the transplant center when the time comes. They may ask you to stay within a certain distance of the hospital to be sure you can arrive quickly.
  • Pack your bags: Have all your insurance and other information, a 24-hour supply of medication, and clothes and other necessities for your hospital stay packed and ready to go.

Once you are called, do not eat or drink anything and keep your phone line open. Wear comfortable clothing.

What happens during the procedure?

The surgery will take place in an operating room under general anesthesia, so you will not be conscious during the procedure. Your blood pressure, heart rate, and oxygen levels will be monitored throughout the surgery. You will be given medication before and during the operation to prevent your body from rejecting the transplant.

Your chest will be opened through an incision along the breastbone, and you will be placed on a cardiopulmonary bypass machine and a ventilator, which do the work of your heart and lungs during the procedure. Almost all heart transplants involve removing the diseased heart and implanting a new one. Rarely, a "piggyback" transplantation may be done, in which the donor heart is implanted but your original heart is left in place as a backup.

In the standard procedure, the diseased heart is removed, leaving in place the large arteries that connect to your heart. The donor heart is then implanted and sewn into place. Because the nerves that run to the heart have been cut during the transplant procedure, the new heart will beat at its default rate (about 100 beats per minute) until the nerves grow back and your body is controlling the new heart’s speed.


A: Cuts are made to remove the diseased heart (all tissue inside the dotted lines is taken out);
B: Donor heart is sewn into place

Once the transplant has been completed, your chest will be closed and the incisions stitched up. You will be sent to the recovery unit to wait for the anesthesia to wear off and begin breathing on your own again.

The entire procedure usually takes around 4 hours, but can last 12 hours or more; every patient is different.

What happens after the procedure?

After the transplant, you will spend the first few days in an intensive care unit. You will have a breathing tube in your throat, so you will not be able to talk or swallow. Tubes in your chest help drain fluid from your lungs and around your heart. The breathing tube will be removed when you are fully awake and able to breathe on your own, and the chest tubes will be taken out when the fluid runs clear.

In a few days, you should be out of bed. You will be transferred to a recovery unit for a week or two until you are well enough to go home. Your general health and how well your new heart is working will determine how long you need to stay.

While you are in the recovery unit, you will begin your rehabilitation and a lifelong health plan that includes medication and frequent monitoring of your new heart. You will need to take several drugs to prevent your body from rejecting the transplant (click here for more). Some you will take for only a short time, others for the rest of your life.

You will also undergo regular blood tests to monitor the levels of medication, and echocardiograms and ECGs to check how well the new heart is working. A heart biopsy will also be performed to make sure your body is not rejecting the implanted heart. You will be told how to take care of the wound and it will be examined for redness, swelling, or drainage (signs of an infection).

What are the risks of a heart transplant?

The risks of heart transplantation include:

  • Rejection of the donor heart by your body’s immune system
  • Infection
  • Complications of the medications
  • Cancer
  • Heart failure or coronary artery disease in the donor heart

Rejection

One of the main risks of heart transplantation is that your body will reject the new heart. Your body’s immune system is designed to protect you from foreign invaders such as bacteria and viruses. Because a transplanted organ is made up of foreign cells, your body will try to attack and destroy them.

To help reduce the risk of rejection, your transplant team will try to match the donor heart as closely as possible to your blood and tissue types. You will also be prescribed drugs called immunosuppresants to slow down your immune system and prevent your body from rejecting the transplanted heart. Some of these drugs are also used to treat rejection if it occurs.

Immunosuppresant Drugs for Heart Transplant8
Drug Type Examples Side Effects
Steroids
  • prednisone (Deltasone)
  • metythlprednisone (Medrol, Solumedrol)
  • High blood pressure
  • Mood swings
  • Muscle weakness
  • Stomach ulcer
  • Excessive hair growth
  • Acne
  • Easy bruising
  • Fragile skin
  • Weight gain
  • Face swelling
Antiproliferative agents
  • azathioprine (Imuran)
  • mycophenolate moefetil (Cellcept)
  • Low blood platelet count
  • Nausea
  • Vomiting
  • diarrhea
Calcineurin inhibitors
  • cyclosporine (Sandimmune, Neoral, Gengraf)
  • tacrolimus (Prograf)
  • sirolimus/rapamyacin (Rapamune)

Despite these precautions, most transplant recipients will experience at least one episode of rejection. This does not mean that your transplant has failed—rejection can be reversed if it is caught early.

Symptoms of rejection include:

  • Fever or chills
  • Shortness of breath
  • Nausea, vomiting, diarrhea
  • Headache, dizziness, aches and pains
  • Difficulty sleeping on your back
  • Weight gain or swelling
  • Irregular heartbeat

If you think you might be experiencing a rejection episode, contact your transplant team immediately. Sometimes your body may be rejecting the new heart but you will not have noticed any symptoms, so it is extremely important that you keep all scheduled follow-up appointments.

Infection

Because you are on medication to suppress your immune system, you have an increased risk of infection. These infections can be treated, so you should contact your doctor immediately if you notice signs of infection such as fever, chills, or unusual pain.

Complications of the Medications

Medications to prevent your body from rejecting the new heart are critical, but they can have serious side effects that need to be monitored and managed. Because of the number of medications and high doses necessary, kidney damage is always a concern, and will affect more than 25% of patients within a year after a transplant.

Cancer

Anti-rejection drugs can increase your risk of developing cancer, particularly skin, lung, cervical and thyroid cancer.9 Be sure to get regular cancer screenings including mammograms, Pap smears, and a colonoscopy, and see a dermatologist to check for skin cancer.

Failure of the Donor Heart

Sometimes the donor heart fails because it was damaged by shock or trauma, or because of narrowed blood vessels in your lungs. This usually happens within the first 30 days after the procedure, and can sometimes be treated. Transplanted hearts are also prone to developing a special type of coronary artery disease called cardiac allograft vasculopathy (CAV), which happens in 30% to 50% of transplant recipients within a few years of surgery.10 Like regular coronary artery disease, CAV increases the risk of dying or developing heart failure in the donor heart. Patients who develop CAV soon after a transplant are twice as likely to die within 5 years as those who do not.10

Life after a Heart Transplant

Most women who receive heart transplants have improved survival, fewer symptoms, are better able to perform daily tasks, and enjoy a better quality of life.4 One in four transplant recipients are able to return to work within a year of the procedure.11

A good outcome after a heart transplant requires a lifelong dedication to health maintenance. You will need to manage multiple medications which must be taken on a strict schedule, be vigilant for symptoms of complications, and keep all follow-up appointments, which are crucial to ensuring you get the longest life out of your donated heart. You may be asked to monitor and record your weight, temperature, blood pressure, pulse and blood sugar (if you have diabetes) every day.

Women who undergo a transplant should participate in a cardiac rehabilitation program to help regain the ability to exercise, perform daily tasks, and to promote general health. You will need to take special care to control high blood pressure, diabetes, and high cholesterol after your transplant. A transplant can cause or make these conditions worse, potentially damaging your new heart. You may also have to make significant lifestyle changes to maintain your newfound health: ask your doctor if there are any dietary guidelines you should follow, and abstain from alcohol and smoking.

You should avoid activities that risk injury within the first year after your transplant. If you are injured and require surgery, there is a greater risk of infection of your transplanted organ.

Some medications can interfere with your transplant, so do not take any new medications (even if they are prescribed by other doctors) without checking with your transplant team. Common medications that can interfere with your transplant include antacids (Tums, Mylanta), antibiotics, blood pressure medication, and common pain relievers (Advil, Motrin). If you are not sure, ask your doctor or pharmacist.

Many women have carried out successful pregnancies after having a heart transplant. However, you will have to wait until you have been clinically stable for a long time, and special precautions must be taken. Talk to you doctor if you are considering planning a pregnancy.

For More Information:

American Society of Transplantation
http://www.healthytransplant.com

Transplant Living – Information on transplant cost and funding
http://www.transplantliving.org

Medications for Keeping Your New Heart or Lung Healthy
http://www.a-s-t.org/files/pdf/patient_education/english/AST-EdBroHEARTMED-ENG.pdf

Become an Organ Donor
http://www.organdonor.gov

References

  1. Hunt SA, Abraham WT, Chin MH, et al. 2009 Focused update incorporated into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the International Society for Heart and Lung Transplantation. J Am Coll Cardiol. Apr 14 2009;53(15):e1-e90.
  2. US DHHS Organ Procurement and Transplantation Network. Current U.S. Waiting List Organs By Gender [Electronic Database]. Available at: http://optn.transplant.hrsa.gov. Accessed July 20, 2009.
  3. Hiemann NE, Knosalla C, Wellnhofer E, Lehmkuhl HB, Hetzer R, Meyer R. Beneficial effect of female gender on long-term survival after heart transplantation. Transplantation. Jul 27 2008;86(2):348-356.
  4. Grady KL, Jalowiec A, White-Williams C. Improvement in quality of life in patients with heart failure who undergo transplantation. J Heart Lung Transplant. Aug 1996;15(8):749-757.
  5. Lloyd-Jones D, Adams R, Carnethon M, et al. Heart disease and stroke statistics--2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation. Jan 27 2009;119(3):e21-181.
  6. Al-Khaldi A, Oyer PE, Robbins RC. Outcome analysis of donor gender in heart transplantation. J Heart Lung Transplant. Apr 2006;25(4):461-468.
  7. Allen MD, Fishbein DP, McBride M, Ellison M, Daily OP. Who gets a heart? Rationing and rationalizing in heart transplantation. West J Med. May 1997;166(5):326-336.
  8. Lindenfeld J, Miller GG, Shakar SF, et al. Drug Therapy in the Heart Transplant Recipient: Part II: Immunosuppressive Drugs. Circulation. December 21, 2004 2004;110(25):3858-3865.
  9. Kellerman L, Neugut A, Burke B, Mancini D. Comparison of the incidence of de novo solid malignancies after heart transplantation to that in the general population. Am J Cardiol. Feb 15 2009;103(4):562-566.
  10. Taylor DO, Edwards LB, Boucek MM, et al. Registry of the International Society for Heart and Lung Transplantation: twenty-fourth official adult heart transplant report--2007. J Heart Lung Transplant. Aug 2007;26(8):769-781.
  11. White-Williams C, Jalowiec A, Grady K. Who returns to work after heart transplantation? J Heart Lung Transplant. Dec 2005;24(12):2255-2261.

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