A heart transplant (Cardiac transplantation) is surgery to replace a patient’s damaged, weakened or diseased heart with a healthy one from a deceased brain-dead person. It is performed on end-stage patients whose condition is so severe there are no other alternatives. It has turned into one of the most common transplant operations in the Western world.
Synonym
Cardiac transplantation
About the Procedure
You will first be placed under deep general anesthetic, and a special device (catheter) will be placed into a vein in the neck. Your surgeon will begin by threading this catheter to the artery that channels blood from your heart to your lungs. Your heart function and all pressures will be measured, including heart, lung and oxygen levels. Your surgeon will feed you medication through the catheter and place a breathing tube in your mouth and down your windpipe. To start the actual surgery, your surgeon will make an incision via your chest and breastbone; this will cause the ribs to split. To free the heart from its usual function, a heart-lung machine will be brought in to take over. The heart will then be removed and replaced with the donated one. After this, with the new heart in place, the blood vessels will be re-attached. Blood circulation and oxygen will begin again, and the heart ought to start beating; if not, an electric shock may be used. When all is working fine, you will be disconnected from the heart-lung machine, and the incision will be closed.
Length
The heart transplant operation usually takes around 4 hours to complete.
Benefits
A successful heart transplant is a huge life saving operation that enables you to return to lead a normal life.
Who is an ideal candidate?
An ideal candidate would be in a life-threatening end-stage situation when nothing but a heart transplant will do. The diseases the candidate would have would be one of the following:
• Coronary artery disease
• Cardiomyopathy (disease of the heart muscle)
• Heart valve disease with congestive heart failure
• Severe heart disease since birth
• Life-threatening abnormal heart beats
Who is not an ideal candidate?
A candidate who would not be ideal would be over 70 years of age, drink alcohol and smoke cigarettes. He would have a history of cancer, malignant tumors, poor blood circulation, high blood pressure in the lungs, active infection throughout the body and be unwilling to change any bad habits after the operation.
Recovery
Immediately after the surgery, you will be moved to ICU where you will be monitored extremely closely; this period is absolutely critical. You will be in ICU for approximately 24-72 hours. You will be scrutinized for any signs of infection or heart rejection as these are the two major causes of death immediately following the operation. Your team will give you medication to counter your body’s natural rejection to the new heart, these drugs are called immunosuppressive. In fact, you will have to continue using these drugs for the rest of your life. It will be around two weeks before you are finally allowed to return home but you ought to be up and walking after just a few days. After you have been discharged from hospital, your cardiologist and doctor will arrange regular medical support including biopsies and other diagnostic tests several times a year. Your new heart should beat faster than before but this is nothing to worry about, it is quite normal. Your doctor will also arrange social workers and psychiatrists to provide both yourself and your family with assistance, as depression is normal after this surgery.
Preparing your surgery
The first stage of preparation involves determining your blood-type so that you are compatible with the donor. O-negative blood though, is compatible with all different blood types. You will be then be given an examination to decipher whether or not you are at high risk; having a hypercute reaction to a donor heart. If you do have such a reaction, your surgeon will plan the procedure differently, crossmatching how close a match is needed between your tissue type and the tissue type of the donor heart. You will be on constant medication to keep the heart well and be regularly checked to see that your heart is still pumping sufficient blood. You will be given a pager, so that when a heart is found you will be able to go to the hospital immediately; the donor heart is only good enough for six hours. It will take your medical team approximately 20 minutes to prepare your body before the actual transplantation takes place,
Risks / Complications / Side effects
Even though this operation is a life-saving one, it also has its risks, they are:
• Failure/ rejection of the donor heart
• Infection
• Cancer
• Death
After your surgery
You will have to continue taking medication for the rest of your life.