Heart Transplant

Heart transplant surgery or a cardiac transplant is a procedure typically performed on patients with end-stage heart failure. In this surgery, a damaged heart is replaced with a healthy one. The most common procedure of the surgery is to take a functioning heart from an ‘organ donor’ and implanting it into the patient. Patient’s own heart is either removed or replaced with the donor’s heart or, much less commonly, the recipient’s diseased heart is left in place to support the donor’s heart.

INDICATIONS
Heart transplant surgery is usually recommended when all other cardiac treatments are failed and when a person’s life is at risk because their heart no longer works effectively. Following are some of the Common reasons why a cardiac transplant is recommended–

• Coronary heart disease – When fatty substances are built in the arteries supplying the heart, which block or interrupt blood flow to the heart.
• Cardiomyopathy – when the walls of the heart have become stretched, thickened or stiff.
• Congenital heart disease – When the heart is defected since birth.

Before making a decision to have a heart transplant, you will be recommended to try drugs, placing pacemakers or exploring one of the many new surgical therapies. If all else fails, the last resort is to have a transplant.

Before the transplantation, the surgeons will look into the following factors –
• If the patient is at risk of dying within the year because of the deteriorating health of his or her heart
• If the patient is suffering from end-stage congestive heart failure or serious coronary artery disease
• When no other treatment works to cure abnormal heartbeats/ rhythms
• The existence of Congenital Heart Disease

PRE-PROCEDURE
Before the transplantation is done your surgeon will first check whether you are a suitable candidate for a transplant or not. Or if you need a new heart? If yes, then there will be additional tests that will be recommended by your surgeon to determine if you can handle the physical stress of the surgery and recovery of a heart transplant. Another major step to look into pre-surgery is finding the right donor if the donor’s heart becomes available tests are performed to see if the donor and the recipient are a good match or if there is any chance of rejection. Then the donor will also undergo evaluations to determine if they have the mental capacity to tolerate the transplant process and to care for themselves and manage an extensive drug regimen after surgery.

Your surgeon will ask you to pursue the following tests before your surgery –
• Liver and kidney function tests
• Tests that will help determine whether your body will accept the foreign heart
• Cancer detection test.

DURING PROCEDURE
Usually, Heart replacement surgery varies depending on the condition of the patient and the doctor’s practice. Surgery begins with going to the operating room and the patient is then given general anesthesia, typically by an anesthesiologist. Once the patient is asleep, the procedure begins by making an incision in the middle of the chest, cutting through both the skin and bone of the chest to expose the heart. In most of the cases, there are two surgeons are operating together to make the transplant process faster and smoother. Then the patient is placed on a heart-lung bypass machine to maintain blood circulation in the body. This step in the surgery is key because the heart is then stopped, then removed from the body and the donor’s heart is placed and sewn into place. Once the heart starts beating, and the final work the breastbone is then re-joined and the skin on it is stitched back together with staples, steristrips, or sutures. The new heart that is placed into the patient’s body starts to beat normally almost immediately. For the purpose of draining air, blood and fluid from the area around the heart few tubes are inserted which also helps in the full re-expansion of the lungs. Then the patient is taken to the ICU to recover and to slowly wake from sedation over the next day or even two days.

POST PROCEDURE
After the procedure, It takes several months to recover and may involve cardiac rehabilitation. After the surgery, the patient is kept under constant monitoring for about 1 to 2 weeks. Most patients are able to leave the hospital within a few weeks of the surgery and are recommended to visit the hospital for follow-up checks and rehabilitation for a few more weeks. During this period, you will also be tested through frequent biopsies to make sure that the heart is not rejecting the body. Furthermore, you will be adviced to take care of your health after discharge. Immunosuppressant medicines are given to patients to prevent rejections. Within six weeks of surgery, the patient may return to many of their normal activities and reach the end of the recovery phase at the three to six-month mark.

RISK AND COMPLICATIONS
Heart transplantation is one of the major surgeries and also have some additional significant risks and complications. For instance, in some of the cases, the patient’s body may reject the new heart. Immunosuppressants are provided to make sure that the immune system doesn’t attack the heart by recognizing it as a foreign body. In addition to this, there are other risks that include –

• Kidney failure due to immunosuppressants
• Infections spread through wounds
• Breathing problems
• Lip and skin cancer due to immunosuppressants
• Development of blood clots or thickening of the coronary arteries that result in heart attacks, lung problems or stroke.

MORE INFO
Heart transplant surgery is a complex surgery often the last resort of treatment for a heart that isn’t functioning well enough to sustain life. It is only done when there are no other options left, and the patient will die from heart disease without a donor’s heart. Getting a transplant is often a long wait that will take a duration of 7-14 day, terribly expensive costing anywhere between $6,500 – $ 11,000 approx and challenging recovery, but once treated successfully the rewards are often great and the extra years of life are of immeasurable value.

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