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
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 decreases blood supply to the heart and may cause serious damage. CAV is the major long-term cause of donor heart failure and death following a heart transplant.
Complications from anti-rejection drugs, including cancer and other side effects
Complications from not following your lifelong healthcare plan necessary after transplantation
Failure of the donor heart
Heart attack or stroke
Rejection of the heart
Reducing your risk of complications
You can reduce the risk of certain complications by following your treatment plan and:
Following activity, dietary and lifestyle restrictions and recommendations
Notifying your doctor immediately of any concerns, such as bleeding, fever, increase in pain, or wound redness, swelling or drainage
Taking your medications exactly as directed
Telling all members of your care team if you have any allergies
How do I prepare for heart transplant?
You are an important member of your own healthcare team. The steps you take before surgery can improve your comfort and outcome.
You can prepare for a heart transplant by:
Answering all questions about your medical history and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.
Getting preoperative testing as directed. Preoperative testing may include a chest X-ray, EKG (electrocardiogram), blood tests, and other tests as needed.
Getting preoperative procedures as directed. The need for these procedures varies. They may include placing an implantable cardioverter defibrillator (ICD) to control abnormal heartbeats or a ventricular assist device (VAD) to help the heart pump.
Not eating or drinking before surgery as directed. Your surgery may be cancelled if you eat or drink too close to the start of surgery because you can choke on stomach contents during anesthesia.
Stopping smoking as soon as possible. Even quitting for just a few days can be beneficial and help the healing process.
Staying in contact with your transplant center as directed and following their guidelines for remaining in the area
Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners.
Questions to ask your doctor
Facing surgery can be stressful. It is common for patients to forget some of their questions during a doctor’s office visit. You may also think of other questions after your appointment Contact your doctor with concerns and questions before a heart transplant and between appointments.
It is also a good idea to bring a list of questions to your appointments. Questions can include:
Why do I need a heart transplant? What are the other options for treating my condition?
How long will the surgery take? When can I go home?
What restrictions will I have after the surgery? When can I return to work? What type of activities might I return to?
What kind of assistance will I need at home?
What medications will I need before and after the surgery? How will these medications affect my lifestyle? What are the risks and complications of these medications?
How will you treat my pain?
What type of tests and regular monitoring and care will I need after going home?
When should I follow up with you?
How should I contact you? Ask for numbers to call during and after regular hours.
What can I expect after my heart transplant?
Knowing what to expect can help make your road to recovery after a heart transplant as smooth as possible.
How long will it take to recover?
You will go to an intensive care unit (ICU) after surgery and initial recovery. ICUs provide 24-hour specialized monitoring and care.
It may take a few hours until the major effects of anesthesia wear off and you are alert. You will have a breathing tube in your mouth and tubes and wires attached to your body. These devices allow your team to monitor vital signs,
drain bodily fluids, take blood, and give medications and fluids.
You will not be able to talk if you have a breathing tube. The care team usually removes it within 24 to 48 hours. You may have a sore throat from the tube. This is usually temporary, but tell your care team if you are uncomfortable.
You will move to a hospital room outside the ICU as you recover. This room will have equipment to monitor your heart rhythm and vital signs. Hospital stays after a heart transplant range from seven to 21 days.
Recovery after surgery is a gradual process. Recovery time varies depending on the procedure, type of anesthesia, your general health, age, and other factors. Your surgeon will refer you to a cardiac rehabilitation program to help you recover. Full recovery takes three to six months.
Will I feel pain?
Pain control is important for healing and a smooth recovery. There will be discomfort after your surgery. Your surgeon and care team will treat your pain so you are comfortable and can get the rest you need.
Tell your care team in the hospital or call your surgeon after you go home if your pain gets worse or changes in any way because it may be a sign of a complication.
When should I call my doctor?
It is important to keep your follow-up appointments after a heart transplant. Contact your surgeon for questions and concerns between appointments. Call your surgeon right away or seek immediate medical care if you have:
Breathing problems, such as shortness of breath, difficulty breathing, labored breathing, or wheezing
Change in alertness, such as passing out, dizziness, unresponsiveness, or confusion
Fever. A low-grade fever (lower than 101 degrees Fahrenheit) is common for a couple of days after surgery and not necessarily a sign of a surgical infection. However, you should follow your doctor's specific instructions about when to call for a fever.
Inability to urinate or have a bowel movement
Pain that is not controlled by your pain medication or any discomfort that is new, worsening or different
Reduced amounts of urine
Sore throat or hoarseness that lasts longer than expected
Unexpected drainage, pus, redness or swelling of your incision
Weight gain, which may indicate that you are retaining fluids. This can be a serious situation.
How might a heart transplant affect my everyday life?
A heart transplant may cure your condition or reduce your symptoms so you can lead a more active, normal life. A heart transplant also causes changes to your body that may affect your everyday life, such as the need to:
Carefully plan any attempt at pregnancy and work closely with all of your healthcare providers before, during and after a pregnancy
Follow a lifelong healthcare plan
Get heart muscle biopsies as directed during the first year after transplantation
Have annual heart catheterizations to make sure you do not develop coronary artery disease
Manage anti-rejection medications and their side effects
Prevent heart rejection with lifelong medications
Treat other conditions, such as diabetes, high blood pressure, and high cholesterol
Watch for signs of rejection
Work through emotional issues and seek appropriate support
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- Heart Transplant. National Heart Lung and Blood Institute. http://www.nhlbi.nih.gov/health/dci/Diseases/ht/ht_whatis.html.
- Pile, JC. Evaluating postoperative fever: A focused approach. Cleveland Clinic Journal of Medicine. 2006;73 (Suppl 1):S62. http://ccjm.org/content/73/Suppl_1/S62.full.pdf.