Heart Transplantation

Introduction

A heart transplant is an operation in which a failing, diseased heart is replaced with a healthier, donor heart. A heart transplant is a major operation.

Indications:

Heart transplants are performed when other treatments for heart problems fail, leading to heart failure. In adults, heart failure can be caused by:

1. Coronary artery disease

2. Heart muscle disease (cardiomyopathy)

3. Valvular heart disease

4. Congenital heart defect

5. Failure of a previous heart transplant

In children, heart failure is most often caused by either a congenital heart defect or a cardiomyopathy.

Contraindications for a heart transplant:

1. Age 65 years or older

2. Presence of another life-threatening medical condition

3. Serious blockages in the arteries of arms or legs (peripheral artery disease)

4. History of cancer

5. Inability or non-compliance to make lifestyle changes

Risks:

After the surgery, patient needs to stay in the hospital for a week or two, and then is closely monitored at the outpatient transplant center for about three months.

Rejection of the donor heart – The immune system considers the donor heart as a foreign object and tries to attack the donor heart. Although all people who receive a heart transplant receive immunosuppressants to reduce the activity of the immune system, about 25 percent of heart transplant recipients still have some signs of rejection during the first year after transplantation. It’s important that transplant recipients follow the instructions outlined by their doctors. Several biopsies are needed to diagnose rejection.

Other important risks:

1. Fever

2. Shortness of breath.

3. Weight gain due to water retention

4. Decreased quantity of urine

5. Fatigue

6. Hardening of the arteries in the heart which can cause a heart attack, heart failure, heart arrhythmias or sudden cardiac death.

7. Side effects due to immunosuppressants such as serious kidney damage and other problems. This also includes increased risk of skin and lip tumors and non-Hodgkin’s lymphoma. There is increased risk of infection due to suppression of immunity.

Preparation:

• If your doctor recommends that a heart transplant is needed, he or she will likely refer you to a heart transplant center for an evaluation.

• Once the decision to have heart transplant is taken, the patient undergoes an evaluation to check the eligibility for a transplant. The evaluation checks if you:

• Have a heart condition which can be benefitted from transplantation

• Might benefit from other less aggressive treatment options

• Are healthy enough to undergo surgery and post-transplant treatments

• Will agree to quit smoking

• Are willing and able to follow the necessary medical program

• Can emotionally handle the period of waiting for a donor heart

• Have a supportive family and friends

Procedure:

• Heart transplant surgery usually takes about four hours or even longer if the patient had previous heart surgeries or if there are complications during the procedure.

• The surgeon opens the chest and connects the patient to a heart-lung machine to keep oxygen-rich blood flowing throughout your body.

• The diseased heart is removed carefully and the donor heart is sewn into place. The new heart often starts beating when blood flow is restored.

• Sometimes an electric shock is needed to make the donor heart beat properly.

• The patient is usually in pain after the surgery, which needs to be treated with medications. Patient is also connected to a ventilator for breathing and tubes are present in the chest to drain fluids from the lungs and heart.

After the procedure

After the surgery, patient needs to stay in the hospital for a week or two, and then is closely monitored at the outpatient transplant center for about three months. At the transplant center, regular tests are done including blood work, echocardiograms, electrocardiograms and heart biopsies.

There are also several long-term adjustments needed after heart transplant. These include:

1. Taking immunosuppressants. These medications decrease the activity of the immune system to prevent it from attacking the new heart. These medications are usually required for the rest of the life.

2. Managing medications and therapies. After a heart transplant, taking all the medications as the doctor instructs is very important. It’s a good idea to set up a daily routine for taking the medications so that you won’t forget.

3. Cardiac rehabilitation. After heart transplant, it may be difficult to adjust to new lifestyle changes, such as diet and exercise. Cardiac rehabilitation programs can help to adjust to these changes.

4. Emotional support. The stress of having a heart transplant may make you feel overwhelmed. Transplant centers often have support groups and other resources to help in managing the condition.

5. Most people who receive a heart transplant can return to work within three to six months of surgery and have few activity restrictions.

Failure of new heart:

If the new heart fails due to organ rejection, development of valvular heart disease or coronary artery disease, the doctor may advice adjusting the medications or in more extreme cases, another heart transplant.