This is a surgery to remove a severely diseased and damaged heart and lungs. They are replaced with a healthy heart and lungs from a deceased donor.
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Reasons for Procedure
A heart-lung transplant is done if you have:
- An irreversible, life-threatening lung disease that affects the heart (but are in otherwise good health)—An example of this is severe pulmonary hypertension, an increase in blood pressure in the lung's blood vessels.
- Had other treatments that have not been successful such as surgery and medications.
If you are planning to have a heart-lung transplant, your doctor will review a list of possible complications, which may include:
- Rejection of the donor heart or lungs
- Coronary artery disease (CAD)
- Blood clots
- Decreased brain functioning
- Damage to other organs, like the kidneys
- Irregular heart rate
- Anesthesia-related problems
- Infection or cancer related to taking immunosuppressive medications
Complications are more likely to occur in people 60 years of age and older. Some factors that may increase the risk of complications include:
- Preexisting heart or lung conditions
- Kidney or liver disease
- Uncontrolled diabetes
- Continued drug abuse or alcohol use disorder
- Poor circulation
- Autoimmune disease
Be sure to discuss these risks with your doctor before the procedure.
What to Expect
Prior to 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 organs become available.
Your doctor will monitor your health to make sure that you are ready for the transplant. Before the surgery, your doctor will likely do the following:
- Physical exam
- Blood tests—to make sure your liver and kidneys are functioning normally
- Identify your blood group
- Tissue typing
Leading up to the surgery:
- Talk to your doctor about your medications. You may be asked to stop taking some medications up to one week before the procedure.
- Do 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.
General anesthesia will be used. It will block any pain and keep you asleep through the surgery. It is given through an IV in your hand or arm.
Description of the Procedure
After you are asleep, an incision will be made in the skin and breastbone. Your 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 the surgery. The lungs and heart will be removed. The donor lungs will be attached. Then, the new heart will be sewn into place. Next, the blood vessels will be connected. The blood will start to flow and warm the heart.
The new heart may begin beating on its own, or the doctor may give you an electrical shock to get the heart started. You will be checked to make sure that there are no leaks and that the heart and lungs are working fine. After this, 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 breastbone will be wired together, and the chest will be closed.
Immediately After Procedure
You will be closely monitored in the intensive care unit (ICU) with the help of the following devices:
- Heart monitor
- Pacing wires used to help control heart rate
- Tubes connected to a machine that helps drain excess blood and air from the chest cavity
- Breathing tube, until you can breathe on your own
How Long Will It Take?
How Much Will It Hurt?
You will have pain during the recovery process. You will be given pain medication.
Average Hospital Stay
This surgery is done in a hospital setting. The usual length of stay is 2 weeks. Your doctor may choose to keep you longer if you shows signs of rejecting the new organs or have other problems.
At the Hospital
While you are recovering at the hospital, you will need to:
- Breathe deeply and cough 10-20 times every hour to help keep your lungs working well.
- 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.
Your doctor may need to take a biopsy of your heart or lungs if you:
- Have persistent fever
- Have poor heart function
- Do not feel well
When you return home, do the following to help ensure a smooth recovery:
- Work with a physical therapist. Keep in mind that your new heart will respond slowly to increases in physical activity.
- Be sure to follow your doctor's instructions.
The surgical site in your breastbone will heal in 4-6 weeks.
Call Your Doctor
It is important for you to monitor your recovery after you leave the hospital. Alert your doctor to any problems right away. If any of the following occur, call your doctor:
- Signs of infection, including fever and chills
- Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision site
- Cough, shortness of breath, chest pain, or severe nausea or vomiting
- Increased sputum (phlegm) production
- Coughing up blood
- Waking up at night due to being short of breath
- Sudden headache or feeling faint
- Changes in weight or blood pressure
- Chest pain or sensation of your heart fluttering, missing beats, or beating erratically
- Pain, burning, urgency, frequency of urination, or persistent bleeding in the urine
- Excessive tiredness or swelling of feet
If you think you have an emergency, call for emergency medical services right away.
Scientific Registry of Transplant Recipients
Heart and Stroke Foundation of Canada
Surgical procedures for heart failure. American Heart Association website. Available at: http://www.heart.org/HEARTORG/Conditions/HeartFailure/TreatmentOptionsForHeartFailure/Devices-and-Surgical-Procedures-to-Treat-Heart-Failure_UCM_306354_Article.jsp#.WiBiEFWnFQI. Updated May 9, 2017. Accessed November 30, 2017.
Explore lung transplant. National Heart, Lung, and Blood Institute website. Available at: https://www.nhlbi.nih.gov/health/health-topics/topics/lungtxp. Updated December 9, 2016. Accessed November 30, 2017.
Last reviewed November 2018 by EBSCO Medical Review Board Michael J. Fucci, DO, FACC Last Updated: 12/20/2014