Heart Transplant Surgery

Listed below is the step by step procedure of heart transplant surgery:

  1. What is Heart Transplant Surgery?
  2. Why is Heart Transplant Surgery?
  3. Pre-operative Preparation
  4. Day Before Surgery
  5. Procedure Day
  6. Methods/Techniques of Heart Transplant Surgery
  7. Post Procedure
  8. Risks and Complications

What is Heart Transplant surgery?

A heart transplant is a procedure which involves replacement of a diseased heart by a healthy human heart obtained from a donor. When the heart is transplanted along with it, the blood vessels attached with it have to be connected properly to the donor's body. Unless all connections are made properly, the transplanted heart will not be able to perform its functions correctly.

Why is Heart Transplant surgery required?

Heart transplant can be indicated in several cases. Most commonly it is required in case of severe heart failure and when one or both ventricles are not functioning in right manner. When other treatments are not working and showing any improvement in the heart condition, heart transplant is recommended.

Indications

  • Heart failure as a result of congenital heart disease or cardiomyopathy and coronary heart disease
  • No response to medications or other treatments by the heart patients
  • Valvular Heart Disease
  • Ischemic and Nonischemic Cardiomyopathy
  • Severe Angina as a result of Coronary Heart Disease

Pre operative preparation

Prior to the heart transplant surgery, cardiac surgeon informs the patient about pros and cons of heart transplant and post operative recovery. Prior to heart transplant surgery, thorough examination of health of the patient is carried out. Blood pressure, pulse rate, respiratory rate and body temperature are measured.

Prior to heart transplant surgery, evaluation of mental health is also necessary. A psychologist helps in determination of drug or alcohol addiction. Emotional problems need to be addressed which can be an interference with the health of the patients.

Choosing the donor heart is a very important and very tedious procedure. The recipient and donor should have matching blood groups, Rh compatibility and antigen-antibody compatibility. This is very important to consider, so that after the transplant, patient's body does not develop auto-immune reaction against the new heart tissue. Blood tests of the patient are carried out to rule out high blood sugar or active infection. ECG is done to assess total heart damage. Patients are prescribed immunosuppresant medicines to be taken before and after surgery.

Day before surgery

Prior to the surgery, patients need to follow food and medication instructions given by the surgeon. Pre-operative basic details and recovery idea needs to be given to the patients and close relatives of the patients by the surgeon. Patients are to report to the hospital one day before the transplant. Continuous medical monitoring of the patient's health is done. Consumption of food since one night prior to surgery is disallowed.

Procedure day

A heart transplant operation generally takes place for around four to six hours. At the beginning of the heart transplant, general anesthesia is given. Patient is made to lie flat on the back. The surgeon will make an incision into the breastbone of the patient for accessing the heart. After that, the patient will be connected to a machine called a heart-lung bypass machine. This helps in the blood circulation throughout the body of the patient. Once this machine is connected, the surgeon begins with the transplant of the heart. After confirmation of stable pumping condition of the heart, the heart-lung bypass machine is disconnected. The breastbone of the patient is closed with th wire. This wire remains for the rest of the life of the patient. After completion of he procedure, patient is moved to an intensive care unit.

Methods/Techniques of Heart transplant surgery

Heart transplant is a relatively simple surgical procedure for a cardiac surgeon. The process of heart transplant involves three operations.

  1. Harvesting the heart from the donor:
    A new heart from a brain dead donor is removed in the first operation. This is carried out once the brain death of the donor is declared. The removed heart is transported through ice to keep it alive until it gets transplanted. In case of the heart, it is less than six hours approximately.
  2. Removal of diseased heart:
    In second operation, diseased heart is removed from the body of the patient. This process can be easy or difficult based on the recipient's health and record of previous heart surgeries. The heart has to be removed, leaving intact connections to be made for new blood vessels with the donated heart.
  3. Implantation of the donor heart:
    Implantation of new heart obtained from the donor is the third operation during heart transplant surgery. This operation involves use of five stitches called as “anastomoses”. These are suture lines for connecting the large blood vessels which enter in and leave from the heart. This can help resume normal blood flow from and out of the heart after transplant surgery. If there are no complications, heart transplant patients can go home within a week after the surgical process.

Post procedure

Post operation there will be sedative effect, and the patient can breath with the help of ventilator. Ventilator is used until the patient is able to breathe properly. Usually patients of the heart transplant can leave the hospital within four weeks post operation. This period varies from patient to patient. Through out this period patient's heart rate, blood pressure, respiratory rate, general health is monitored. Weakness, loss of strength is normal and reduces slowly. Weight lifting and stressful activities need to be avoided by the patients. Any pain, fever, bleeding from surgical wounds or discomfort needs to be reported immediately to the surgeon.

Possibility of rejection of new heart by the patient

After the process of heart transplant, surgeon will monitor the patient for the heart rejection signs. There is a possibility of rejection of new heart by the patient as a result of immune response of the body. It is normal reaction of the body to reject any foreign objects. For allowing the transplanted heart survive in the body, immunosuppressants are required to be given to these patients. This helps the immune system to accept the new heart.

Immunosupressants used for prevention of heart rejection are very important. Without these medicines, the body may find the new heart as a foreign entity and will attack it. This attack is known as rejection. In some cases, immunosuppressive agents may show side effects, such as infection, kidney disease, diabetes or high blood pressure. If such type of difficulties arise, surgeon may change the dose of medications or change the immunosuppressive agent.

Diet

A well- balanced diet to ensure good health is recommended in general. A healthy diet helps in reducing the risk of immunosuppressant side effects. Food which is low on unhealthy fats is advised to be consumed.

Smoking and alcohol

Since smoking and alcohol consumption are harmful, patients of the heart transplant need to avoid them completely.

Activities post surgery

One should not drive for at least one month post heart transplant surgery. Advice from surgeon needs to be followed regarding driving and traveling. Most of the patients can return to normal routine post surgery within six months. Time period to get back to the work depends on the recovery of the patients.

Medical Follow-up

Regular check ups after heart transplant procedure are very essential. Blood tests can be carried out by the cardiologist for checking immunosuppressive agent concentration and side effects of the same. An electrocardiogram and echocardiogram is also required to be carried out.

Risks and complications

Given below are the potential risks associated with heart transplant surgery.

  • Bleeding during or post surgery
  • Infections
  • Formation of blood clots which may lead to heart attack, lung trouble or stroke.
  • Kidney failure
  • Failure of the donor heart
  • Breathing trouble
  • Death

Heart is one of the main organs of human body. Getting it replaced with a new one from the donor is not easy. It is not easy for the human body to accept the organs from donors, though with compatible blood groups heart transplants can be carried out. In emergency cases, such as severe heart failure, there are no other options but the heart transplant.

It is possible to live healthily after heart transplant if all of the pre and post operative instructions are followed carefully.



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