This is surgery to remove a severely diseased and failing heart. It is replaced with a healthy heart from a deceased donor.
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Reasons for Procedure
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 cardiomyopathy, which is a disease of the heart muscle, along with severe heart failure.
- Severe coronary artery disease that cannot be fixed with medication or other surgeries.
- Congenital heart defects that cannot be fixed with medication or other surgeries.
- Valvular 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.
Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:
- Rejection of the new heart
- Fluid around the heart
- New heart does not work well
- Blood clots
- Decreased brain function
- Damage to other body organs, such as the kidneys
- Irregular heart rate
- Anesthesia-related problems
- Infection or cancer 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.
People over 60 years old are at increased risk of complications. Some factors that may increase the risk of complications include:
- Lung disease
- Poor circulation
- Kidney or liver disease
- Presence of serious active infection, such as pneumonia or tuberculosis
- Treatment for cancer within the past five years
- Fatigue and malnourishment
- Uncontrolled type 2 diabetes
- Previous stroke or other damage to the blood vessels of the brain
- Continued substance abuse or alcohol use disorder
- 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 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.
Before the procedure:
- Your doctor will monitor your health to make sure that you are ready for the heart transplant.
- Talk to your doctor about all medications you are taking. You may be asked to stop taking some medications before surgery.
- 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.
Before the surgery, your doctor will likely do the following:
- Physical exam
- Cardiac catheterization
- Monitor your electrocardiogram
- Echocardiogram —to examine the size, shape, and motion of your heart
- Identify your blood and tissue type
- Tests to exclude diseases in other organ systems that may prevent you from receiving a transplant
General anesthesia will be used. You will be asleep during the procedure.
Description of the Procedure
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. Most of your 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 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 slowly turned down and 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.
Immediately After Procedure
You will be closely monitored in the intensive care unit (ICU) with the help of some/all of the following:
- Heart monitor
- Pacing wires used to help the heart beat normally
- Tubes connected to a machine that helps drain excess blood and air
- Breathing tube, until you can breathe on your own
- Medications to support heart function
- An IV
- A central line
You will also have your vital signs monitored.
How Long Will It Take?
Will It Hurt?
Anesthesia will prevent pain during surgery. Pain and discomfort after the procedure can be managed with medications.
Average Hospital Stay
This procedure is done in a hospital setting. The usual length of stay is at least 2 weeks. Your may need to stay longer if you shows signs of rejecting the new heart 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.
- 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 stockings
- Have blood tests
Your doctor may need to take a biopsy of your heart routinely and additionally as needed 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:
- Return as prescribed by your transplant cardiologist for follow up coronary angiography and biopsies.
- Work with a physical therapist. Keep in mind that your new heart will respond slowly to increases in physical activity.
Adults will be started on cholesterol reducing medications 1-2 weeks after surgery
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
- Changes in sensation, movement, or circulation in your arms or legs
- Changes in the location, type, or severity of pain
- Chest pain, pressure, or a return of your previous heart pain
- Fast or irregular heart rate
- Pain that does not improve with the medications you were given
- Cough or shortness of breath
- Coughing up blood
- Severe nausea or vomiting
- Sudden headache or feeling faint
- Waking up at night due to being short of breath
- Excessive tiredness, swelling of feet
- Pain, burning, urgency, frequency of urination, or persistent bleeding in the urine
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
Cardiac transplantation immunosuppressive and adjunctive therapy. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T909193/Cardiac-transplantation-immunosuppressive-and-adjunctive-therapy. Updated December 16, 2015. Accessed August 29, 2017.
Cardiac transplantation procedure and immediate postoperative care. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T909192/Cardiac-transplantation-procedure-and-immediate-postoperative-care. Updated October 30, 2015. Accessed August 29, 2017.
Explore heart transplant. National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov/health/health-topics/topics/ht. Updated December 9, 2016. Accessed August 29, 2017.
Evaluation and management of patients after cardiac transplantation. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T909194/Evaluation-and-management-of-patients-after-cardiac-transplantation. Updated December 1, 2015. Accessed August 29, 2017.
Heart transplant. American Heart Association website. Available at: http://www.heart.org/HEARTORG/Conditions/CongenitalHeartDefects/CareTreatmentforCongenitalHeartDefects/Heart-Transplant_UCM_307731_Article.jsp. Updated July 24, 2015. Accessed August 29, 2017.
Patient's guide to heart transplant surgery. University of Southern California website. Available at: http://www.cts.usc.edu/ht-pg-hearttransplantprocedure.html. Accessed September 19, 2017.
Selection and timing of patients for cardiac transplantation. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T906136/Selection-and-timing-of-patients-for-cardiac-transplantation. Updated August 11, 2017. Accessed August 29, 2017.
Last reviewed September 2018 by EBSCO Medical Review Board Michael Woods, MD, FAAP Last Updated: 9/30/2014