A heart transplant is performed to treat heart failure due to disease or injury. A donor heart is removed from a person deemed brain dead. The heart is then transplanted into the recipient.
In general, patients with advance heart failure, on maximal medical therapy should be considered for transplant evaluation. Patients with increasing medication requirements, frequent hospitalizations, or overall deterioration of clinical status should be referred for evaluation. Some causes of heart failure that result in cardiac transplantation are primary cardiomyopathy, coronary artery disease, with either resultant ischemic cardiomyopathy and symptoms of congestive heart failure or inoperable ischemic heart disease with refractory chest discomfort or arrhythmia.
A small percentage of patients who undergo cardiac transplantation do so for idiopathic dialated cardiomyopathy, valvular heart disease, congenital heart disease and inoperable hypertrophic cardiomyopathy. All candidates for transplantation enter the program with a comprehensive series of tests conducted by our multidisciplinary team of specialists. Some of these tests are required for any operative procedure (history and physical chest x-ray EKG etc.) while others (such as specific blood tests) are required for transplantation surgery.
A doctor will insert an intravenous (IV) line into a vein in your arm to deliver fluids and medications, and you will be given anesthesia to make you unconscious. After your surgeon inspects the donor heart to confirm that it looks healthy and suitable for transplantation, he or she will make a large incision in the middle of your chest. You will be placed on a heart-lung machine, which pumps your blood during surgery. The surgeons removes your failing heart, then positions the donor heart in your chest and sutures it in place. Your new heart was cooled to preserve it before transplantation. As it warms up to room temperature, it might begin to beat on its own. If not, the surgeon may trigger your heart to start beating with an electric shock. Once your new heart pumps steadily without leaks, the surgical team disconnects you from the heart-lung machine and stitches your chest closed. You are then taken to the intensive care unit for monitoring. After two or three days in the intensive care unit, you can move to a private room. You will continue to be monitored, and will get daily blood tests and echocardiograms until you are stable enough to go home. The total hospital stay is usually 10 to 14 days.
After a heart transplant, a person usually stays in the intensive care unit for 7 to 14 days. Often he or she will stay on an artificial breathing machine, or ventilator, overnight. On the second or third day, the person may be well enough to move out of the ICU. Generally, he or she can start eating again within 2 to 5 days. Medications to prevent rejection of the new heart are begun at the time of surgery. A combination of 2 or 3 different medications is given. Rejection of the heart may occur without any early symptoms, so frequent biopsies are done. A small tube is passed through the jugular vein in the neck and into the heart. A tiny piece of heart muscle tissue is removed and is examined under a microscope for signs of tissue rejection. Before leaving the hospital, the person will receive a lot of information from the transplant team. He or she will learn the importance of taking medications as prescribed. Signs of rejection are stressed so that the person and family know what to watch for. A program of exercise and rehabilitation will also be prescribed.
One of the main complications following heart transplantation is rejection. The body's immune system treats the new organ as foreign tissue and produces antibodies to destroy it. Immunosuppressive drugs such as cyclosporine are given to suppress this response. In cases of severe rejection, retransplantation may be considered if a new donor can be found. In the past, side effects of anti-rejection drugs kept elderly persons and infants from being recipients of heart transplants. Now, improvements in the field have made it possible for many newborns to those in their seventies to be eligible for a transplant.