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What is a heart transplant?

Believe it or not, heart transplantation is a relatively simple operation for a cardiac surgeon. In fact, the procedure actually consists of three operations

The First Operation

The first operation is harvesting the heart from the donor. The donor is usually an unfortunate person who has suffered irreversible brain injury, called "brain death". Very often these are patients who have had major trauma to the head, for example, in an automobile accident. The victim's organs, other than the brain, are working well with the help of medications and other "life support" that may include a respirator or other devices. A team of physicians, nurses, and technicians goes to the hospital of the donor to remove donated organs once brain death of the donor has been determined. The removed organs are transported on ice to keep them alive until they can be implanted. For the heart, this is optimally less than six hours. So, the organs are often flown by airplane or helicopter to the recipient's hospital.

The Second Operation

The second operation is removing the recipient's damaged heart. Removing the damaged heart may be very easy or very difficult, depending on whether the recipient has had previous heart surgery (as is often the case). If there has been previous surgery, cutting through the scar tissue may prolong and complicate removal of the heart.

The Third Operation

The third operation is probably the easiest; the implantation of the donor heart. Today, this operation basically involves the creation of only five lines of stitches, or "anastomoses". These suture lines connect the large blood vessels entering and leaving the heart. Remarkably, if there are no complications, most patients who have had a heart transplant are home about one week after the surgery. The generosity of donors and their families makes organ transplant possible
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A heart transplant is surgery to remove a person's diseased heart and replace it with a healthy heart from a deceased donor. Ninety percent of heart transplants are done on patients who have end-stage heart failure.

The heart is located in the chest cavity, or thorax. It pumps blood from the lungs to the rest of the body.

A heart transplant may be recommended for heart failure caused by:

coronary artery disease
cardiomyopathy (thickening of the heart walls)
heart valve disease with congestive heart failure
severe congenital heart disease

Heart transplant surgery is not recommended for patients who have:

kidney, lung, or liver disease
insulin-dependent diabetes mellitus (IDDM)
other life-threatening diseases

Heart transplants are the third most common (corneas and kidneys are the most common) transplant operations in the U.S. (over 1,500 cases per year). A healthy heart is obtained from a donor who has suffered brain death but remains on life-support. The healthy heart is transported in a special solution that preserves the organ. While the patient is deep asleep and pain-free (general anesthesia), an incision is made through the breast bone (sternum). The patient's blood is re-routed through tubes to a heart-lung bypass machine to keep the blood oxygen-rich and circulating. The patient's diseased heart is removed and the donor heart is stitched in place.

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Heart transplant prolongs the life of a patient who otherwise would die. About 80% of heart transplants are alive two years after the operation. The main problem, as with other transplants, is graft rejection. If rejection can be controlled, then survival can be increased up to 10 years or more. Immunosuppressive drugs must be taken indefinitely. Relatively normal activities can resume as soon as the patient feels well enough and after consulting with his or her doctor. However, vigorous physical activities should be avoided.

The major problems are the same all major organ transplants face:

a shortage of donor hearts
rejection of the transplanted heart
cost of the surgery and post-operative care, including immunosuppressive drugs

The Transplant Procedure :

When a heart becomes available and is approved for a patient, it is packed in a sterile cold solution and rushed to the hospital where the recipient is waiting.

Heart transplant surgery involves the following basic steps:

  • A specialist in cardiovascular anesthesia gives the patient general anesthesia.
  • Intravenous antibiotics are usually given to prevent bacterial wound infections.
  • The patient is put on a heart/lung machine, which performs the functions of the heart and lungs and pumps the blood to the rest of the body during surgery. This procedure is called cardiopulmonary bypass.
  • After adequate blood circulation is established, the patient's diseased heart is removed.
  • The donor heart is attached to the patient's blood vessels.
  • After the blood vessels are connected, the new heart is warmed up and begins beating. If the heart does not begin to beat immediately, the surgeon may start it with an electrical shock.
  • The patient is taken off the heart/lung machine.
  • The new heart is stimulated to maintain a regular beat with medications for two to five days after surgery, until the new heart functions normally on its own.

Heart transplant recipients are given immunosuppressive drugs to prevent the body from rejecting the new heart. These drugs are usually started before or during the heart transplant surgery. Immunosuppressive drugs keep the body's immune system from recognizing and attacking the new heart as foreign tissue. Normally, immune system cells recognize and attack foreign or abnormal cells, such as bacteria, cancer cells, and cells from a transplanted organ.

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Who Needs a Heart Transplant?

Most patients referred to a heart transplant center have end-stage heart failure. Of these patients, close to half have heart failure as a result of coronary heart disease (also called coronary artery disease). Others have heart failure caused by hereditary conditions, viral infections of the heart, or damaged heart valves and muscles. (Some medicines, alcohol, and pregnancy can damage the heart valves and muscles.) Most patients considered for a heart transplant have tried other, less drastic treatments and have been hospitalized a number of times for heart failure.

Who Is Eligible for a Heart Transplant?

The heart transplant specialists at the heart transplant center will determine whether a patient is eligible for a transplant. Specialists often include :

Cardiologist (a doctor who specializes in diagnosing and treating heart problems)
Cardiovascular surgeon (a doctor who does the transplant surgery)
Transplant coordinator (a person who makes arrangements for the surgery, such as transportation of the donor heart)
Social worker

What To Expect Before a Heart Transplant ?

Patients who are eligible for a heart transplant are placed on a waiting list for a donor heart. This waiting list is part of a national allocation system for donor organs run by the Organ Procurement and Transplantation Network (OPTN).
OPTN has policies in place to make sure donor hearts are given out fairly. These policies are based on urgency of need, the organs that are available for transplant, and the location of the patient who is receiving the heart (the recipient).

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What To Expect During a Heart Transplant ?

Just before the heart transplant surgery, patients will get general anesthesia "anesthesia" refers to a loss of feeling and awareness. General anesthesia temporarily puts you to sleep. A bypass machine is hooked up to the arteries and veins of the heart. The machine pumps blood through the patient's lungs and body while the diseased heart is removed and the donor heart is sewn into place

What To Expect After a Heart Transplant ?

In the Hospital

The amount of time a heart transplant recipient spends in the hospital will vary with each person. It often involves 1 to 2 weeks in the hospital and 3 months of monitoring by the transplant team at the heart transplant center. Monitoring may include frequent blood tests, lung function tests, EKGs (electrocardiograms), echocardiograms, and biopsies of the heart tissue.

A heart biopsy is a standard test used to see whether your body is rejecting the new heart. It might be done often in the weeks after a transplant. During a heart biopsy, a tiny grabbing device is inserted into a vein in the neck or groin (upper thigh). The device is threaded through the vein to the right atrium of the new heart to take a small tissue sample. The tissue sample is checked for signs of rejection.

What Are the Risks of a Heart Transplant?

Risks of heart transplant include:

Failure of the donor heart
Complications from medicines
Problems that arise from not following a lifelong health care plan
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