Heart transplant

Definition

A heart transplant is surgery to remove a damaged or diseased heart and replace it with a healthy donor heart.

Description

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 in normal condition without disease and must be matched as closely as possible to your blood and /or 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.

Why the Procedure Is Performed

A heart transplant may be done to treat:

Heart transplant surgery may not be used in people who:

Risks

Risks from any anesthesia are:

Risks from any surgery are:

Risks of transplant include:

Before the Procedure

Once you are referred 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 regional waiting list for a heart:

Most, but not all, people who are waiting for a heart transplant 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 (VAD).

After the Procedure

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 3 months and often, your transplant team will ask you to stay fairly close to the hospital during that time period. 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 a foreign body and fights it. For this reason, organ transplant patients must take drugs that suppress the body's immune response. To prevent rejection, it is very important to take these medicines and carefully follow your self-care instructions.

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 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 medicines, and know their side effects.

You can go back to your normal activities 3 months after the transplant as soon as you feel well enough, and after talking with your health care provider. Consult your provider if you plan to engage in vigorous physical activity.

If you develop coronary disease after a transplant, you may have cardiac catheterization every year.

Outlook (Prognosis)

Heart transplant prolongs the life of people who would otherwise die. About 80% of heart transplant patients are alive 2 years after the operation. At 5 years, 70% of patients 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.


Review Date: 4/3/2019
Reviewed By: Mary C. Mancini, MD, PhD, Director, Cardiothoracic Surgery, Christus Highland Medical Center, Shreveport, LA. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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