Overview
A heart transplant is the replacement of a diseased heart with a healthy heart. Recently, there has been a successful procedure where a heart was replaced with an artificial heart, but this procedure is still relatively new. Heart transplants are usually performed in cases where the heart is seriously diseased but the patient is still healthy enough to withstand extensive, invasive surgery.
Detailed Description
Ninety-five percent of heart transplant patients are able to perform daily activities after surgery. Eighty percent live more than one year after their surgery. And 70% are able to return to work.
One major roadblock in front of this treatment is the long waiting list for donors. You can find out more information about the waiting list by going to the website for the United Network for Organ Sharing (UNOS).
Before the procedure
Some patients are able to live at home and continue some daily activities while waiting for a donor heart. If that is the cases, the patient carries a pager at all times. When someone willing to donate a heart dies, the doctor will page the transplant recipient, and the recipient will come immediately to the hospital. In other cases, the patient must stay in the hospital connected to mechanical heart machines for weeks or months before a heart is found. Some patients die waiting.
Once a donor dies, his or her heart can only live for four to six hours outside of the body. The new heart may be at the hospital where the surgery is to take place, or it may be transported from somewhere else.
During the procedure
When the patient arrives at the hospital, the chest will be shaved if necessary and cleaned with antiseptic, and an intravenous line will be started. The patient cannot be given anesthetic until 20 minutes before the surgery is to start, so there may be some waiting.
First, a catheter will be threaded through the jugular vein to the pulmonary artery, which carries blood from the heart to the lungs. This catheter measures heart function, pressure and oxygen levels, and delivers medication.
The doctor breaks the sternum in two, and separates the ribs to access the failing heart. While the heart is being removed, the patient will be put on a heart-lung bypass machine, which will pump oxygen into your blood and throughout your body while the operation is going on. The new heart is put in place, and blood vessels are attached. The new heart should start when the blood begins circulating again, but if it does not, the doctor can use a defibrillator.
After the surgery
The patient will spend up to two weeks in the hospital, and at least two months recovering at home, before resuming normal activities.
Every transplant recipient is expected to reject the heart at least twice. Hopefully these episodes will be mild; if they are not, the patient may need to return to the transplant waiting list. Rejection means that the immune system senses an unwanted object and goes into overdrive, creating fever, weakness and abnormal heartbeats. Because of this risk, the transplant recipient will have to take immunosuppressent drugs for the rest of his or her life. The amount of drugs may need to be modified, however, because the body may at first reject the heart anyway. The doctor may suspect rejection based on reported symptoms, but there may be no symptoms. In that case, an electrocardiogram may show evidence. Diagnosis is confirmed with a biopsy. In this procedure, a catheter is threaded to the heart to remove heart tissue.
A good resource for heart conditions is the website Jon’s place. This website also has a page specifically for information about transplants.
Last updated: 31-May-04
