Heart Transplant: Procedure,Risks, and Recovery

What Is Heart Transplant?

A heart transplant is a surgical procedure that involves replacing the failing, diseased heart with a healthier heart. This procedure is for patients with end-stage heart failure or severe coronary artery disease or any other heart conditions who do not get relieved through medications or other surgical interventions. 

Candidacy for Heart Transplant

Cardiologists recommend heart transplants to patients suffering from end-stage cardiac failure. Various conditions that may result in cardiac failure include:

• Hypertension 

• Cardiomyopathy

• Cardiac infections

• Coronary artery disease

• Congenital heart disease (birth defects in the heart) 

• Ventricular arrhythmia that remains unmanaged through conventional treatment

• Inherited cardiac disease

• Blocked valves or valve dysfunction

• Weakening of heart due to pregnancy or childbirth

• Failure of the previous heart transplant surgery

However, not all the patients suffering from one or more of the above conditions are eligible for undergoing a heart transplant. A patient may be rejected for a heart transplant if:

• The surgeon thinks that the person may not be able to handle the physical and mental stress of the surgery

• The patient suffers from an infection

• The patient refuses to take the precautions that are critical for the successful outcome of the surgery

• The patient is suffering from any other life-threatening conditions such as kidney or liver disease or a condition that may reduce his life

• The patient is of advanced age and has difficulty in recovering

Preparation Before Heart Transplant

Once the doctor advises the patient for a heart transplant, the transplant team, comprising of cardiac surgeon, psychologist, anesthesiologist, and cardiac physician, will evaluate the patient. Simultaneously with the evaluation, the patient may obtain the information related to the procedure of surgery, cost, and any other preparation he must do before surgery. It is better to note all the questions and ask from the review team. If the patients fulfill the criteria for undergoing a heart transplant, the staff lists his name in the organ transplant registry.   

Once the patient receives the information about the availability of a heart donor, he should visit the hospital immediately for surgery. The transplant is usually performed 4 hours within its removal from the donor. 

What Is the Procedure?

The procedure initiates with general anaesthesia given to the patient. Because of the complexity of the surgery, it may take 4-6 hours for a heart transplant. It may take longer if the patient has previous heart surgery or an underlying medical condition.

The surgeon connects the patient to the heart-lung bypass machine. It will circulate the blood during surgery until the patient receives the donor's heart.  The surgeon makes an incision on the skin, cuts the sternum, detaches the blood vessels attached, and removes the diseased heart. The surgeon places the donor's heart and attaches the blood vessels. Once all the vessels are connected, the surgeon allows the blood to flow through the heart. The surgeon starts the heartbeat with the help of small paddles.  During the surgery, the patient has a catheter to drain urine, a tube to remove stomach fluid, and an IV line in the arm.

The cardiac surgeon monitors the functioning of blood and looks for possible leakages. Upon satisfaction, the surgeon joins the sternum with wires. The surgeon covers the incised skin with sutures or surgical staples.

Recovery

After the heart transplant surgery, the nursing staff shifts the patient to the Intensive Care Unit (ICU). The vital parameters of the patients are under constant monitoring through ECG, blood pressure, heartbeat, and oxygen level analysis. 

The patient must stay at the hospital for 7-14 days after surgery. In the hospital, the patient starts moderate activity such as walking. 

On the day of discharge, the healthcare team provides detailed information about the precautionary measures to be taken during the recovery period. The team also schedules the follow-up visit of the patient. 

The patient should take the medications strictly as prescribed by the doctor. Most patients recover fully within 6-months after the surgery.

After Surgery Precautions

For a successful outcome of the heart transplant, the patient should strictly follow the precautionary measures advised by the doctor. These include:

• Taking medicines as prescribed.

• For the initial 8-12 weeks after surgery, the patient should refrain from lifting heavy objects or straining on one side of the body.

• Not skipping the scheduled follow-up visit.

• Informing the doctor immediately in case the patient experiences fatigue, difficulty breathing, or low blood pressure

• Taking a healthy diet and performing exercises suggested by the doctor.

Lifestyle Factors

Incorporating positive changes in the lifestyle increases the chances of successful heart transplant surgery. The patient may have the following changes in lifestyle:

• Quit smoking.

• Take fruits, vegetables, and lean meat in the diet.

• Limit the quantity of sugar and salt.

• Avoid foods that have a high concentration of sodium.

• Not taking trans fats or saturated fats.

• Drink enough fluid to stay hydrated.

• Do routine exercises such as stretching, walking, cycling, or strength exercise suggested by the doctor.

• Patients may participate in a cardiac rehabilitation program.

 

 Dr Y K Mishra

Chief Of Clinical Services, Head Of Cardiac Sciences And Chief Cardio Vascular Surgeon

Manipal Hospital, Dwarka, Delhi