A heart transplant is an open-heart surgery in which a severely diseased or damaged heart is replaced with a healthy heart from a recently deceased person. It may be a treatment option for heart failure due to conditions such as coronary artery disease, cardiomyopathy Cataract Surgery Cost , congenital heart disease or valve disease.
Heart transplantation has made great strides over the years. Today, more than 85 percent of heart recipients will live at least an additional year and more than 70 percent will live five more years. However, patients continue to face a lengthy waiting list to receive a donor heart.
Researchers are working to develop equipment to improve the health and comfort for patients waiting for a donor heart and, ideally, to develop a mechanical heart that could permanently solve the shortage problem.
People who receive a heart transplant can expect to spend 10 days to two weeks in the hospital. The medical team will join them in the fight to keep the new heart free from infection or rejection by the body.
After being discharged from the hospital, patients must continue to take their medications and keep follow-up appointments. There are many changes that come with having a new heart, and depression is not uncommon. The support of family and friends during this difficult time is an important part of recovery.
About heart transplants
A heart transplant is an open-heart surgery in which a severely diseased or damaged heart is replaced with a healthy heart from a recently deceased person. Heart transplants have been successfully performed since 1967.
Unfortunately, the number of people waiting for a heart transplant is higher than the number of available organs. A patient generally becomes eligible for a heart transplant when diagnosed as having end-stage heart disease, all other medical interventions have failed and the patient is stable enough to sustain a major surgery.
Coronary artery disease and cardiomyopathy are the most common heart conditions that may lead to a heart transplant. Other diseases include congenital heart disease (the most common reason for heart transplant in children), failure of a previous bypass or heart transplant and valvular heart disease. These conditions can lead to heart failure, in which the heart is unable to meet the body’s demand for blood.
Most heart transplant patients are white males, according to the American Heart Association. More than half are between the ages of 50 and 64, and about 20 percent are between the ages of 35 and 49.
Heart transplants are sometimes performed along with lung transplants for individuals with end-stage lung disease due to conditions including:
Primary pulmonary hypertension. High blood pressure in the blood vessels of the lungs. This is considered a contraindication for a straight heart transplant, making a lung transplant necessary.
Eisenmenger syndrome. Any type of congenital heart disease that involves severe pulmonary hypertension. The condition accounts for nearly half of all heart-lung transplants.
Cystic fibrosis. A genetic disease that causes thick mucus to build up in the lungs.
Bronchiectasis. Destruction and widening of the lungs’ large airways.
Before the heart transplant procedure
Patients waiting for a donor heart will generally carry a pager and be “on call. ” When a suitable donor heart becomes available, the patient will be paged and told to come to the hospital immediately.
If the donor heart is in the same hospital as the recipient, then the surgery will be done as soon as all preparations have been made. If the donor heart is being transported by ambulance or by air, then the surgical team responsible for the transfer will keep the hospital team informed of its progress.
The hospital team will require about 20 minutes to prepare the donor for removal of the heart. Time is critical, because the donor heart can survive for only four to six hours outside the body.
After arriving at the hospital, the patient will be given specific preoperative medications and prepped for surgery. First, the chest area is shaved (if necessary). Next, the surgical team creates a sterile environment by swabbing the patient’s chest with an antiseptic solution and covering the area in sterile surgical drapes. An intravenous (IV) line will be started, usually in the forearm or back of the hand.
When the time is right, the patient is given general anesthesia through the IV line. The patient will continue to breathe a mixture of oxygen and anesthetic gas to remain asleep throughout the surgery.
During the heart transplant procedure
After the patient is asleep, a device called the Swan-Ganz catheter may be inserted into the jugular vein in the neck. It is then threaded to the pulmonary artery, which transports blood from the heart to the lungs. The catheter measures heart function, pressures within the heart and lungs and oxygen levels within the blood. Medication is also delivered through the Swan-Ganz catheter. A breathing tube (endotracheal tube) will be inserted into the mouth and down the windpipe (trachea) to maintain an airway.
An incision is made through the chest and breastbone (sternum), and the ribs are separated. A heart-lung machine takes over the functions of the heart and lungs, freeing the heart from its normal function so that it can be removed. Some heart muscle is reserved during extraction to act as a support for the new heart as it is sewn into place.
When the new heart is positioned and the blood vessels are reattached, the heart incision is closed, the heart is restarted and blood circulation and oxygen are restored. The warmth of the blood should “wake up” the heart and stimulate it to start beating. If this does not occur, it may be necessary to start the heart using an electric shock (defibrillation). Once the blood is flowing through the new heart normally and without any leaks, the heart-lung machine is disconnected and the chest incision is closed.
After the heart transplant procedure
Continuous monitoring will follow the surgery. During this critical time, the cardiac surgeon, cardiologist and other members of the hospital staff will watch closely for any signs of heart rejection or infection. These are the two leading causes of death immediately after a heart transplant. Medications that suppress the body’s natural immune system will be administered to counter the body’s tendency to reject the new heart. These medications have dramatically reduced the number of rejections.