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Heart Transplant

by Cynthia M. Johnson, MA

Definition

A heart transplant removes a severely diseased and failing heart and replaces it with a healthy heart from a deceased donor.

Normal Heart and Heart with Hypertrophic Cardiomyopathy

Hypertrophic Cardiomyopathy
Copyright © Nucleus Medical Media, Inc.

Reasons for Procedure

A heart transplant is done when all other methods have failed. It may be done because of:

Possible Complications

All procedures have some risk. The doctor will go over some problems that could happen, such as:

  • Excess bleeding
  • Problems from anesthesia, such as wheezing or sore throat
  • Infection
  • Blood clots
  • Rejection of the new heart
  • Fluid around the heart
  • Irregular heart rate
  • Damage to other body organs, such as the kidneys
  • Pneumonia
  • Death

Things that may raise the risk of problems are:

What to Expect

Prior to Procedure

It may take some time to find a heart from a donor. Once one is found, the surgical team will meet with you to talk about:

  • Anesthesia options
  • Any allergies you may have
  • Current medicines, herbs, and supplements that you take and whether you need to stop taking them before surgery
  • Fasting before surgery, such as avoiding food or drink after midnight the night before
  • Specialists you may need to see
  • Tests that will need to be done before surgery, such as an echocardiogram, electrocardiogram, and cardiac catheterization

Anesthesia

General anesthesia will be used. You will be asleep.

Description of the Procedure

An incision will be made in the breastbone. The chest will be opened. You will be connected to a heart-lung machine. It will take over the job of the heart and lungs during surgery. Most of the heart will be removed. The back wall of the left atrium with the pulmonary vein openings will be left in place. The donor heart will be prepared and sewn into place in the chest. 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 help start it. 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 slowly turned down and disconnected. Tubes may be placed in the chest cavity to drain any blood that has collected. The breastbone will be closed with stainless steel wires. The skin will be closed with absorbable stitches.

Immediately After Procedure

You will be taken to the intensive care unit (ICU) for observation. This may include:

  • A breathing machine until you can breathe on your own
  • Medications to support heart function
  • Pacing wires to help the heart beat normally
  • Tubes connected to a machine to help drain excess blood and air

How Long Will It Take?

8 hours

Will It Hurt?

Pain and swelling are common for several weeks. Medicine and home care help.

Average Hospital Stay

The usual length of stay is two weeks. If you have any problems, you may need to stay longer.

Post-procedure Care

At the Hospital

While you are recovering, the staff may:

  • Give you pain medicines
  • Start you on medicines to suppress the immune system so your body does not reject the transplant
  • Teach you breathing exercises to prevent infection
  • Put compression socks on you to lower the risk of blood clots in the legs

Samples of your heart will need to be taken at regular intervals to look for signs of rejection. This can be done with biopsies.

During your stay, the hospital staff will take steps to lower your risk of infection, such as:

  • Washing their hands
  • Wearing gloves or masks
  • Keeping your incisions covered

There are also steps you can take to lower your risk of infection, such as:

  • Washing your hands often and reminding visitors and staff to do the same
  • Reminding staff to wear gloves or masks
  • Not letting others touch your incisions

At Home

It will take about eight weeks for the incision and muscles to fully heal. Full recovery will take about six months. Physical activity will be limited during this time. You will need to ask for help with daily activities and delay your return to work.

Problems to Look Out For

Call your doctor right away if you are not getting better or you have:

  • Signs of infection, such as fever and chills
  • Redness, swelling, excessive bleeding, or discharge from the incision
  • Pain that does not get better with medicine
  • Changes in feeling, movement, or blood flow in the arms or legs
  • Swelling in the feet
  • Chest pain, pressure, or symptoms that return
  • Fast or irregular heart beat
  • Cough or shortness of breath
  • Coughing up blood
  • Nausea and vomiting
  • Sudden headache
  • Lightheadedness
  • Lack of energy
  • Pain, burning, urgency, frequency of urination, or blood in the urine

If you think you have an emergency, call for medical help right away.

RESOURCES:

Scientific Registry of Transplant Recipients
https://www.srtr.org
Transplant Living—United Network for Organ Sharing
http://www.transplantliving.org

CANADIAN RESOURCES:

Health Canada
http://www.canada.ca
Heart and Stroke Foundation of Canada
http://www.heartandstroke.ca

References:

Cardiac transplantation immunosuppressive and adjunctive therapy. EBSCO DynaMed website. Available at: https://www.dynamed.com/management/cardiac-transplantation-immunosuppressive-and-adjunctive-therapy. Accessed March 23, 2021.
Cardiac transplantation procedure and immediate postoperative care. EBSCO DynaMed website. Available at: https://www.dynamed.com/management/cardiac-transplantation-procedure-and-immediate-postoperative-care. Accessed March 23, 2021.
Evaluation and management of patients after cardiac transplantation. EBSCO DynaMed website. Available at: https://www.dynamed.com/management/evaluation-and-management-of-patients-after-cardiac-transplantation. Accessed March 23, 2021.
Explore heart transplant. National Heart, Lung, and Blood Institute website. Available at: https://www.nhlbi.nih.gov/health-topics/heart-transplant. Accessed March 23, 2021.
Fischer S, Glas KE. A review of cardiac transplantation. Anesthesiol Clin. 2013 Jun;31(2):383-403.
Heart transplant. American Heart Association website. Available at:
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Accessed March 23, 2021.
Selection and timing of patients for cardiac transplantation. EBSCO DynaMed website. Available at: https://www.dynamed.com/procedure/selection-and-timing-of-patients-for-cardiac-transplantation. Accessed March 23, 2021.
Last reviewed June 2021 by EBSCO Medical Review Board Daniel A. Ostrovsky, MD
Last Updated: 6/3/2021