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
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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
, which is a disease of the heart muscle, along with severe congestive heart failure.
coronary artery disease
that cannot be fixed with medication or other surgeries
Congenital heart defects that cannot be fixed with medication or other surgeriesValvular 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
If you are planning to have a heart transplant, your doctor will review a list of possible complications, which may include: InfectionRejection of the new heartCoronary artery diseasePneumoniaBlood clotsBleedingDecreased brain functionDamage to other body organs, such as the kidneysIrregular heart rateAnesthesia-related problems
related to taking immunosuppressive medications
More than 80% of heart transplant patients live for at least one year after surgery. Most return to normal activities, including work and exercise.
Some factors that may increase the risk of complications include: Age: 60 or olderLung diseasePoor circulationKidney or liver diseaseSmoking
Presence of serious active infection, such as
within the past five years
Fatigue and malnourishment
or other damage to the blood vessels of the brain
alcohol abuseAutoimmune disease
Be sure to discuss these risks with your doctor before the 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. Your doctor will monitor your health to make sure that you are ready for the heart transplant.
Talk to you doctor about all medications you are taking. You may be asked to stop taking:
Anti-inflammatory medications, such as ibuprofenBlood-thinning medicationsAnti-platelet medicationsDo 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 examCardiac catheterizationEchocardiogram
—to examine the size, shape, and motion of your heart
Identify your blood and tissue typeTests to exclude diseases in other organ systems that may prevent you from receiving a transplant
will be used. It will block pain and keep you asleep through the surgery. It is given through an IV.
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.
You will be closely monitored in the intensive care unit (ICU) with the help of some/all of the following: Heart monitorPacing wires used to help the heart beat normallyTubes connected to a machine that helps drain excess blood and airBreathing tube, until you can breathe on your ownMedications to support heart functionAn IV
You will also have your vital signs monitored.
You will have pain during the recovery process. Your doctor will give you pain medication.
This procedure is done in a hospital setting. The usual length of stay is at least two weeks. Your doctor may choose to keep you longer if you shows signs of rejecting the new heart or have other problems.
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 stockingsHave blood tests
Your doctor may need to take a
of your heart routinely and additionally as needed if you:
Have persistent feverHave poor heart functionDo not feel well
When you return home, do the following to help ensure a smooth recovery: Take medications as directed.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.Ask your doctor about when it is safe to shower, bathe, or soak in water.Ask for help at home. Your doctor may refer a visiting nurse to assist you at home in the early stages of recovery.
Be sure to follow your doctor's
The surgical site in your breastbone will heal in 4-6 weeks.
After you leave the hospital, contact your doctor if any of the following occur: Signs of infection, including fever and chillsRedness, swelling, increasing pain, excessive bleeding, or discharge from the incision siteChanges in sensation, movement, or circulation in your arms or legsChanges in the location, type, or severity of painChest pain, pressure, or a return of your previous heart painFast or irregular heart ratePain that does not improve with the medications you have been givenCough or shortness of breathCoughing up bloodSevere nausea or vomitingSudden headache or feeling faintWaking up at night due to being short of breathExcessive tiredness, swelling of feetPain, burning, urgency, frequency of urination, or persistent bleeding in the urine
In case of an emergency,
get medical care right away
Last reviewed September 2013 by Michael Woods, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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