Heart transplantation or cardiac transplantation, is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease. The most common procedure is to take a working heart from a recently deceased organ donor (allograft) and implant it into the patient. The patient's own heart may either be removed (orthotopic procedure) or, less commonly, left in to support the donor heart (heterotopic procedure). It is also possible to take a heart from another species (xenograft), or implant a man-made artificial one, although the outcome of these two procedures has been less successful in comparison to the far more commonly performed allografts.
A heart transplant is an open-heart surgery in which a severely diseased or damaged heart is replaced with a healthy heart from a recently deceased person.
Coronary artery disease and cardiomyopathy are the most common heart conditions that may lead to a heart transplant. Other diseases include congenital heart disease (the most common reason for heart transplant in children), failure of a previous bypass or heart transplant and valvular heart disease. These conditions can lead to heart failure, in which the heart is unable to meet the body's demand for blood.
Heart transplants are sometimes performed along with lung transplants for individuals with end-stage lung disease due to conditions including:
Primary pulmonary hypertension : High blood pressure in the blood vessels of the lungs. This is considered a contraindication for a straight heart transplant, making a lung transplant necessary.
Eisenmenger syndrome : Any type of congenital heart disease that involves severe pulmonary hypertension. The condition accounts for nearly half of all heart-lung transplants.
Cystic fibrosis : A genetic disease that causes thick mucus to build up in the lungs.
Bronchiectasis : Destruction and widening of the lungs' large airways.
Heart transplant surgery involves removing most of your diseased heart and inserting one from a person who has died. You will be called to come to the hospital immediately once you have been assigned a donor heart. Upon arrival, you will go the Coronary Care Unit for a physical exam and more tests, including blood and urine samples.
You will be prepared for surgery, which includes the insertion of intravenous lines and a catheter in your neck to measure the pressure in your heart.
You will be given anesthesia so that you will sleep through the surgery. You also will receive immunosuppressive drugs before and during the procedure to prevent your body from rejecting the new heart.
The surgery involves:
A major incision down your chest. Your breastbone is split in half.
Your main arteries are connected to a heart lung bypass machine to pump your blood and a ventilator will help you breathe.
Most heart transplants are done with a method called orthotopic surgery, where most of your heart is removed but the back half of both upper chambers, called atria, are left in place. Then the front half of the donor heart is sewn to the back half of the old heart.
The donor's aorta and pulmonary arteries are connected to yours. The bypass machine is disconnected and your new heart begins the work of pumping blood.
Your incisions are closed.
This surgery is considered less complicated than most heart bypass surgeries, including coronary artery bypass graft (CABG).
After your surgery, you will wake up in a special sterile room to ensure that you aren't exposed to infection. Staff and visitors must take measures to make sure that they do not bring in bacteria and infections by scrubbing their hands and wearing protective masks and gowns.
Once you are able to breathe on your own, the ventilator will be removed. However, you will continue to be hooked up to various monitors and catheters for a while. When you are stronger, you may be moved to a more general hospital room.
You will have to take precautions to prevent your exposure to infection for the rest of your life. Much of the rest of your hospital recovery will include education and training about taking care of yourself. This includes learning about the anti-rejection medications you will need to take, how to follow a heart-healthy low-fat diet and other changes.
If you don't have any complications, you will be in the hospital about 10 days.