Heart Transplant

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KEY POINTS

• A heart transplant is surgery to replace a damaged or diseased heart with a healthy donor heart. A heart transplant may be done when medicines or other treatments have not worked well and you have a severe or life-threatening heart problem.
• If a heart transplant is your best option, your name will be placed on a list of people waiting for a donor heart. When a matching donor heart is found, you will be notified and told to go quickly to the transplant center.
• After transplant surgery, you need to take medicine to keep your body from rejecting the heart. You will take these medicines for the rest of your life.
• Ask your provider how long it will take to recover and how to take care of yourself at home.
• Make sure you know what symptoms or problems you should watch for and what to do if you have them.

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What is a heart transplant?

A heart transplant is surgery to replace a damaged or diseased heart with a healthy donor heart. The donor is a person who has recently died, and whose heart is close to the size of your heart.

When is it used?

A heart transplant may be done when medicines or other treatments have not worked well and you have severe or life-threatening:

• Heart muscle or heart valve disease
• Heart defects that you were born with
• Heart rhythm problems

How do I prepare for this procedure?

Your healthcare provider will refer you to an evaluation team at a hospital where this kind of surgery is done. Tests may include:

• A physical exam
• Blood tests, lung tests, and kidney tests
• Tests of tissue types to find out what tissue will most closely match yours
• Heart tests, which may include:
  • A chest X-ray
  • An ECG (also called an EKG or electrocardiogram), which measures and records the heartbeat
  • An echocardiogram, which uses sound waves (ultrasound) to see how well the heart is pumping
  • Heart catheterization, which uses a small tube called a catheter inserted into a blood vessel, dye, and X-rays to look at your blood vessels and heart.

If a heart transplant is your best option, your name will be placed on a list of people waiting for a donor heart. There are not enough donor hearts for everyone who needs one. The match is based on how closely the donor tissue matches your tissue and on the severity of your illness. Patients waiting for a donor are kept on both a regional and national list.

While waiting for a donor heart:

• You will continue to get treatment to help your heart work better.
• You will learn about the diet you need to follow and medicines you need to take after surgery.
• You will be given a pager so the transplant center can contact you if a heart becomes available for you.

Always keep a bag packed in case you are called. When a matching donor heart is found, you will be notified and told to go quickly to the transplant center. The transplant team will prepare for immediate surgery. The donor heart needs to be transplanted no more than 6 hours after its removal from the donor.

What happens during the procedure?

You will be given a general anesthetic to keep you from feeling pain. General anesthesia relaxes your muscles and you will be asleep.

Your surgeon will make a cut in your chest and divide your breastbone. You will be connected to a heart-lung machine that will take over the work of your heart and lungs during the operation. Your failing heart will be removed and the donor heart will be sewn in place. Your new heart will begin beating right away. Your provider will wire your breastbone together and close the skin with stitches. Some tubes will be left in your chest to drain blood and fluid.

What happens after the procedure?

You may need to be in the intensive care unit (ICU) for the first few days. Most people are home within 30 days of surgery. How long you will be in the hospital depends on how your body reacts to the new heart.

Your body will respond to the new heart as something foreign and will try to reject it. Almost all people who get transplants have some rejection. It usually happens during the first 3 months after surgery.

To check for rejection, you will have biopsies regularly after your transplant. A biopsy is the removal of a small sample of tissue for testing. You will be given a local anesthetic so that you will not feel any pain during the procedure. Your provider will insert a thin, flexible tube (catheter) through a vein in your neck and then move it through the vein into your heart. Your provider will remove a very small piece of muscle from inside the heart.

You need to take medicine to keep your body from rejecting the heart. You will take these medicines for the rest of your life. Your provider may change the dosage of your medicines, depending on biopsy results.

Follow your healthcare provider’s instructions. Ask your healthcare provider:

• How long it will take to recover
• If there are activities you should avoid and when you can return to your normal activities
• How to take care of yourself at home
• What symptoms or problems you should watch for and what to do if you have them

Make sure you know when you should come back for a checkup. Keep all appointments for provider visits or tests.

What are the risks of this procedure?

Every procedure or treatment has risks. Some possible risks of this procedure include:

• You may have problems with anesthesia.
• Your body may reject the donor heart.
• You may have infection, bleeding, or blood clots. The medicine to prevent rejection may weaken your ability to fight infections. Infections can quickly become a serious problem.
• The medicine to prevent rejection may cause side effects such as high blood pressure, high cholesterol, kidney damage, small shaking movements of the arms and legs, and diabetes.
• You may develop fatty deposits that build up in your new heart arteries and make them narrower.
• You may develop emotional problems due to stress or the medicines you take.

Ask your healthcare provider how these risks apply to you. Be sure to discuss any other questions or concerns that you may have.