Health Information

Heart Transplant

Definition

This is surgery to remove a severely diseased and failing heart. It is replaced with a healthy heart from a deceased donor.

Normal Heart and Heart With Hypertrophic Cardiomyopathy
Hypertrophic Cardiomyopathy
Copyright © Nucleus Medical Media, Inc.

Reasons for Procedure

A heart transplant is done if you have:

  • End stage heart disease that is life threatening and cannot be fixed with medication or other surgeries, but you are in otherwise good health—This is most often due to cardiomyopathy , which is a disease of the heart muscle, along with severe congestive heart failure.
  • Severe coronary artery disease that cannot be fixed with medication or other surgeries
  • Congenital heart defects that cannot be fixed with medication or other surgeries
  • Valvular defects that cannot be fixed with medication or other surgeries—This condition makes it too hard for the heart to pump blood through the body.
  • Uncontrollable life-threatening irregular heart rhythms that cannot be fixed with medication or other surgeries

Possible Complications

If you are planning to have a heart transplant, your doctor will review a list of possible complications, which may include:

  • Infection
  • Rejection of the new heart
  • Coronary artery disease
  • Pneumonia
  • Blood clots
  • Bleeding
  • Decreased brain function
  • Damage to other body organs, such as the kidneys
  • Irregular heart rate
  • Anesthesia-related problems
  • Infection or cancer related to taking immunosuppressive medications
  • Death

More than 80% of heart transplant patients live for at least one year after surgery. Most return to normal activities, including work and exercise.

People over 60 years old are at increased risk of complications. Some factors that may increase the risk of complications include:

Be sure to discuss these risks with your doctor before the procedure.

What to Expect

Prior to Procedure

There is a shortage of donors, so you may be on a transplant list for some time. You may need to carry a cell phone with you at all times. This is to allow the transplant team to reach you if a donor heart becomes available.

You may need to stay in the hospital for monitoring. You may need to be on continuous IV medications to help stabilize the function of your diseased heart. Some may need to have a mechanical pump called a ventricular assist device (VAD). The device will help to stabilize your heart while you are waiting for a transplant.

Before the procedure:

  • Your doctor will monitor your health to make sure that you are ready for the heart transplant.
  • Talk to your doctor about all medications you are taking. You may be asked to stop taking some medications before surgery.
  • Do not take over-the-counter medication without checking with your doctor.
  • Arrange for a ride to and from the hospital.
  • Arrange for help at home after the surgery.
  • Eat a light meal the night before the surgery. Do not eat or drink anything after midnight.

Before the surgery, your doctor will likely do the following:

  • Physical exam
  • Cardiac catheterization
  • Echocardiogram —to examine the size, shape, and motion of your heart
  • Identify your blood and tissue type
  • Tests to exclude diseases in other organ systems that may prevent you from receiving a transplant

Anesthesia

General anesthesia will be used. It will block pain and keep you asleep through the surgery. It is given through an IV.

Description of the Procedure

After you are asleep, the doctor will cut through the skin and breastbone. The chest will be opened and you will be connected to a heart-lung machine. This machine takes over the functions of the heart and lungs during surgery. Your heart will be removed. The donor heart will be prepared and sewn into place in your chest. Next, the blood vessels will be connected. After this, the blood will start to flow and warm the heart.

The new heart may begin beating on its own, or you may be given an electrical shock to get your heart started. For safety, you will also have a temporary pacemaker attached to the heart to help the heart beat stay regular. After the doctor is sure that the heart is beating fine, the blood will be rewarmed. The heart-lung machine will be disconnected. Next, temporary tubes may be placed in the chest cavity to drain any blood that has collected. The chest will be closed with stainless steel wires. Lastly, the skin will be closed with absorbable sutures.

Immediately After Procedure

You will be closely monitored in the intensive care unit (ICU) with the help of some/all of the following:

  • Heart monitor
  • Pacing wires used to help the heart beat normally
  • Tubes connected to a machine that helps drain excess blood and air
  • Breathing tube, until you can breathe on your own
  • Medications to support heart function
  • An IV

You will also have your vital signs monitored.

How Long Will It Take?

8 hours

Will It Hurt?

You will have pain during the recovery process. You will be given pain medication.

Average Hospital Stay

This procedure is done in a hospital setting. The usual length of stay is at least two weeks. Your may need to stay longer if you shows signs of rejecting the new heart or have other problems.

Post-procedure Care

At the Hospital

While you are recovering at the hospital, you will need to:

  • Breathe deeply and cough 10-20 times every hour.
  • Take immunosuppressive drugs—You will likely need to take these for the rest of your life. These drugs reduce the chance that your body will reject the new heart.
  • Take measures to prevent blood clots, such as wearing compression stockings
  • Have blood tests

Your doctor may need to take a biopsy of your heart routinely and additionally as needed if you:

  • Have persistent fever
  • Have poor heart function
  • Do not feel well
At Home

When you return home, do the following to help ensure a smooth recovery:

  • Return as prescribed by your transplant cardiologist for follow up biopsies.
  • Work with a physical therapist. Keep in mind that your new heart will respond slowly to increases in physical activity.
  • Be sure to follow your doctor's instructions .

Call Your Doctor

After you leave the hospital, contact your doctor if any of the following occur:

  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision site
  • Changes in sensation, movement, or circulation in your arms or legs
  • Changes in the location, type, or severity of pain
  • Chest pain, pressure, or a return of your previous heart pain
  • Fast or irregular heart rate
  • Pain that does not improve with the medications you have been given
  • Cough or shortness of breath
  • Coughing up blood
  • Severe nausea or vomiting
  • Sudden headache or feeling faint
  • Waking up at night due to being short of breath
  • Excessive tiredness, swelling of feet
  • Pain, burning, urgency, frequency of urination, or persistent bleeding in the urine

In case of an emergency, get medical care right away .

Revision Information

  • Scientific Registry of Transplant Recipients

    http://www.srtr.org

  • Transplant Living

    http://www.transplantliving.org

  • Health Canada

    http://www.hc-sc.gc.ca

  • Heart and Stroke Foundation of Canada

    http://ww2.heartandstroke.ca

  • Heart transplant. American Heart Association website. Available at: http://www.heart.org/HEARTORG/Conditions/CongenitalHeartDefects/CareTreatmentforCongenitalHeartDefects/Heart-Transplant%5FUCM%5F307731%5FArticle.jsp. Updated September 9, 2014. Accessed September 30, 2014.

  • What is a heart transplant? National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov/health/dci/Diseases/ht/ht%5Fwhatis.html. Updated January 3, 2012. Accessed September 30, 2014.