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Heart Transplant

By

Sarah Lewis, PharmD

What is a heart transplant?

A heart transplant is a surgery that replaces a damaged or diseased heart with a healthy donor heart. It is a treatment for end-stage heart failure and other severe heart conditions. Heart transplantation is a life-saving surgery used when all other medical and surgical options have failed. 

The most common type of heart transplant is an orthotopic heart transplant, in which the original heart is removed and replaced with a donor heart. A heterotopic heart transplant involves sewing a donor heart next to the original heart.

A heart transplant is a major surgery with significant risks and potential complications. You may have less invasive treatment options. Consider getting a second opinion about all your treatment choices before having a heart transplant. 

Other procedures that may be performed

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Your doctor may perform other procedures in addition to a heart transplant. Diseases that cause serious damage to the heart can also cause serious damage to other organs. These include the kidney, lung and liver. For example, cystic fibrosis can damage both the heart and the lungs. 

Some patients may need another organ transplant in addition to a heart transplant. Your doctor will determine your eligibility for combination transplant surgery.

Combination transplant surgeries are rare but can include:

  • Kidney transplant replaces a diseased or damaged kidney with a donor kidney.

  • Liver transplant replaces a diseased or damaged liver with a donor liver.

  • Lung transplant replaces a diseased or damaged lung with a donor lung. 

Why is a heart transplant performed? 

Your doctor may recommend a heart transplant that is used to treat end-stage heart failure and other severe heart conditions. End-stage heart failure is the most common reason for a heart transplant.

Heart failure is also called congestive heart failure. It is a condition in which the heart cannot pump enough oxygenated blood to meet the needs of the body's tissues and organs. The heart keeps pumping, but not as efficiently as a healthy heart. 

Heart failure is usually a symptom of another heart problem. Heart failure can result from coronary artery disease, heart valve disease, high blood pressure (hypertension), heart infection (endocarditis), and disease of the heart muscle (cardiomyopathy).

Your doctor will only consider a heart transplant for you if all other medical and surgical treatment options have failed. Ask your doctor about all of your treatment options and consider getting a second opinion before deciding on a heart transplant.

Your doctor may recommend a heart transplant to treat: 

  • Congenital heart defects, which are heart defects present at birth

  • End-stage heart failure, the most advanced form of heart failure in which a person is generally disabled and unable to function in even very light activities

  • Life-threatening arrhythmias, which are abnormal heartbeats, or heart rhythms

  • Severe angina, heart disease-related chest pain that is unresponsive to all other treatments

Who performs a heart transplant?

A cardiac surgeon who specializes in transplant surgery performs a heart transplant. Cardiac surgeons specialize in the surgical treatment of conditions of the heart and its blood vessels. A cardiac surgeon may also be known as a cardiothoracic surgeon. Cardiac transplant surgeons have completed additional education and training in a heart transplant fellowship program.

How is a heart transplant performed?

Your heart transplant will be performed in a hospital. It requires open heart surgery. Open heart surgery involves making an incision in the chest and through the breastbone (sternum).

Heart transplant surgery uses a heart-lung machine (cardiopulmonary bypass). This machine temporarily takes over the heart’s job of pumping oxygen-rich blood to your organs and tissues. It allows your surgeon to remove the heart and sew in the donor heart. The surgery takes four hours or longer.

Your surgeon will advise you on how long you need to stay in the hospital based on a variety of factors based on your diagnosis, age, medical history, and general health. 

Types of anesthesia that may be used

Your surgeon will perform your heart transplant using general anesthesia. General anesthesia is a combination of intravenous (IV) medications and gases that put you in deep sleep. You are unaware of the surgery and will not feel any pain.

You may also receive a peripheral nerve block infusion in addition to general anesthesia. A peripheral nerve block infusion is an injection or continuous drip of liquid anesthetic. The anesthetic flows through a tiny tube inserted near your surgical site to control pain during and after surgery.

What to expect the day of your heart transplant

You will be placed on a heart transplant waiting list if you are eligible for a heart transplant. A variety of factors determines who gets a donor heart when one becomes available. These factors include tissue, blood, and size matching. 

Sometimes a donor heart matches more than one person on the waiting list. In this case, length of time on the waiting list and physical location in relation to the donor heart may play a role in who gets the heart. 

A donor heart generally needs to be transplanted within four hours. Patients waiting for a heart are often in the hospital already. If not, most transplant centers require patients to be in immediate contact while on the waiting list. Your transplant center may expect you to arrive at the hospital within two hours of contact. 

When you arrive at the transplant center, you can generally expect to:

Talk with a preoperative nurse. The nurse will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure you understand and sign the surgical consent form.

Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member. Your care team will give you blankets for modesty and warmth.

  • Talk with the anesthesiologist or nurse anesthetist about your anesthesia.

  • A surgical team member will start an IV.

  • The anesthesiologist or nurse anesthetist will start your anesthesia.

  • A tube will be placed in your windpipe to protect and control breathing during general anesthesia. You will not feel or remember this or the surgery as they happen.

  • A catheter (tube) will be placed in your bladder to collect urine during and after the surgery.

  • The surgical team will monitor your vital signs and other critical body functions. This occurs throughout the surgery and your recovery until you are alert, breathing effectively, and your vital signs are stable.

What are the risks and potential complications of a heart transplant?  

As with all surgeries, a heart transplant involves risks and potential complications. Complications may become serious and life threatening in some cases. Complications can develop during surgery or recovery.  

General risks of surgery 

The general risks of surgery include: 

  • Anesthesia reaction, such as an allergic reaction and problems with breathing 

  • Bleeding, which can lead to shock

  • Blood clot, in particular a deep vein thrombosis that develops in the leg or pelvis

  • Infection of the surgical incision or area

  • Pneumonia, which is a lung infection

Potential complications of a heart transplant

Complications of a heart transplant include:

  • Cardiac allograft vasculopathy (CAV). This is a chronic condition. It occurs when the coronary arteries on the new heart become narrowed. Coronary arteries supply the heart with blood. CAV decrease