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A heart transplant is surgery to remove a damaged or diseased heart and replace it with a healthy donor heart.
Cardiac transplant; Transplant - heart; Transplantation - heart
Finding a donor heart can be difficult. The heart must be donated by someone who is brain-dead but is still on life support. The donor heart must be matched as closely as possible to your tissue type to reduce the chance that your body will reject it.
You are put into a deep sleep with general anesthesia, and a cut is made through the breastbone.
A heart transplant may be done to treat:
Heart transplant surgery may not be used in patients who:
The doctor may not recommend a heart transplant if the patient may not be able to keep up with the many hospital and doctor's office visits, tests, and medications needed to keep the new heart healthy.
Risks from any anesthesia are:
Risks from any surgery are:
Risks of transplant include:
Once the doctor refers you to a transplant center, you will be evaluated by the transplant team. They will want to make sure that you are a good candidate for a transplant. You will visit many times over several weeks or even months. You will need to have blood drawn and x-rays taken. The following may also be done:
You will want to look at one or more transplant centers to see which would be best for you:
If the transplant team believes you are a good candidate, you will be put on a national waiting list for a heart:
Most, but not all, patients who are waiting for heart transplants are very ill and need to be in the hospital. Many will need some sort of device to help their heart pump enough blood to the body. Most often this is a ventricular assist device (artificial heart-like device).
You should expect to stay in the hospital for 7 to 21 days after a heart transplant. The first 24 to 48 hours will likely be in the intensive care unit (ICU). During the first few days after a transplant, you will need close follow-up to make sure that you do not get an infection and your heart is working well.
The recovery period is about 6 months. Often, your transplant team will ask you to stay fairly close to the hospital for the first 3 months. You will need to have regular check-ups with blood tests, x-rays, and echocardiograms for many years.
Fighting rejection is an ongoing process. The body's immune system considers the transplanted organ an infection and fights it. For this reason, organ transplant patients must take drugs that suppress the body's immune response. Taking medicines and following your doctor's instructions carefully is very important to preventing rejection.
Biopsies of the heart muscle are often done every month during the first 6 to 12 months after transplant, and then less often after that. This helps the doctor determine if your body is rejecting the new heart, even before you have symptoms.
You must take drugs that prevent transplant rejection for the rest of your life. You will need to understand how to take these medications, and know their side effects.
You can go back to your normal activities as soon as you feel well enough, and after talking with your doctor. However, avoid vigorous physical activity.
To make sure that you do not develop coronary disease after a transplant, you may have cardiac catheterization every year.
Heart transplant prolongs the life of patients who would otherwise die. About 80% of heart transplant patients are alive 2 years after the operation. At 5 years, 70% of people will still be alive after a heart transplant.
The main problem, as with other transplants, is rejection. If rejection can be controlled, survival increases to over 10 years.
Bernstein D. Pediatric heart and heart-lung transplantation. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 437.
Acker MA, Jessup M. Surgical management of heart failure. In: Bonow RO, Mann DL, Zipes DP, Libby P, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 9th ed. Philadelphia, PA: Saunders Elsevier; 2011:chap 31.
Costanzo MR, Dipchand A, Starling R, Anderson A, Chan M, Desai S, et al. International Society of Heart and Lung Transplantation Guidelines. The International Society of Heart and Lung Transplantation Guidelines for the care of heart transplant recipients. J Heart Lung Transplant. 2010;29(8):914-956.
Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG, et al. 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation. Circulation. 2009; 119(14):1977-2016.