Heart transplant: procedures, risks and follow-up care

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Definition of a heart transplant

What is a heart transplant?

A heart transplant is a medical procedure that places a healthy heart from a donor into a person with a heart problem. This operation is also known as an orthotopic heart graft.

This medical procedure is usually reserved for people with heart disease and their condition does not improve adequately with drugs or other heart disease treatments.

The reason is, the heart itself is a vital organ in charge of pumping oxygen-rich blood throughout the body. If the heart has a problem, blood circulation to the body's cells will be disrupted. Without treatment, tissue death can occur and will be life-threatening.

Through this treatment, people who are at high risk for life-threatening conditions related to the heart can have the opportunity to lead a better life.

When is a heart transplant needed?

A heart transplant is the treatment usually used as a last resort, when other heart treatments have not worked and can lead to heart failure.

Heart failure itself is a condition that indicates the heart muscle cannot pump blood properly. The following are various conditions that can cause heart failure:

• Cardiomyopathy (weakening of the heart muscle).
• Heart valve disease (a condition that causes the heart valves to not function properly).
• Atherosclerosis (plaque clogging the arteries) and coronary heart disease (obstructed blood flow to the heart due to narrowing of the arteries).
• Congenital heart disease (defects in the heart from birth).
• Recurrent and dangerous arrhythmias (heart rhythm disturbances).
• Previous heart transplant failure.

Other organ transplants can be performed at the same time as heart transplants (multiorgan transplants) in people with certain conditions at certain medical centers.

People who are not recommended a heart transplant

Although effective, not everyone is suitable for this treatment. Some of the following people who are not eligible for heart transplant surgery include:

• Have an active infection in the body.
• Have a history of cancer.
• Unwilling or unable to obey the rules to change a healthier lifestyle, such as still smoking and drinking alcohol.
• He is old and the body's ability to recover from surgery is very slow.

Risks and side effects of a heart transplant

The impact that appears after the heart transplant operation is bleeding and infection in the incision scar. In addition, it can also cause blood clots that can lead to a heart attack or stroke.

Not only that, there are also other complications that may occur, as reported by the Mayo Clinic, in the form of:

• The body rejects the new heart from the donor

This condition usually occurs when the immune system detects the donor heart as a threat. To prevent this, the doctor will prescribe immunosuppressant drugs. However, this drug can also increase the risk of kidney damage.

• Primary graft failure

This effect can cause death within a few months after the operation is performed because the donor's heart is not functioning.

• Cancer

Immunosuppressant drugs can also increase the risk of cancer, especially malignant tumors on the skin and lips.

• Artery problems

It is possible for the artery walls in the heart to thicken and harden causing cardiac allograft vasculopathy. This condition can later lead to heart attacks, heart failure, arrhythmias, and cardiac arrest.

Preparation before heart transplant

Some things to consider in a heart transplant evaluation are:

• Have a heart condition that would benefit from a transplant.
• May benefit from other, less aggressive treatment options.
• Healthy enough to undergo surgery and post transplant care.
• Agree to undergo healthier lifestyle changes, such as quitting smoking.
• Willing to wait for the donor's heart organ.

Preparations that need to be done

Preparation for a heart transplant often starts weeks or months before you receive a donor heart. You may be referred to a heart transplant center for evaluation.

Prepare a suitcase that contains everything you need to stay in the hospital, as well as a supply of medicines that you take every day.

Once you arrive at the hospital, your doctor and surgical team will conduct a final evaluation to determine if a donor heart is suitable for you and whether you are ready for surgery.

If your doctor determines that a donor heart or surgery isn't right for you, you may not be able to have a transplant that day.

Heart transplant procedure

The heart transplant process is an open heart procedure that takes about 4 hours or more. If you have had heart surgery before, it will be more complicated, so it will take longer.

Steps of the heart transplant procedure

• You will receive general anesthesia before the procedure to prevent pain. Then, your surgeon will connect your body to a heart-lung bypass machine to keep the oxygen-rich blood flowing throughout your body.
• Next, the surgeon will make an incision in the chest and separate the sternum to open the ribs. The goal is to make it easier for doctors to access your heart.
• Then, the surgeon will remove the problematic heart and sew the donor heart into place. Then, the main blood vessels will be connected to the donor heart.
• A new heart often starts beating when blood flow is restored. Sometimes an electric shock is needed to stimulate the donor's heart to beat properly.
• You will be given medication to help control pain after the surgery. You will also have a ventilator to help you breathe and a tube in your chest to drain fluid from around your lungs and heart.

After surgery, you will also receive fluids and medicines through an intravenous (IV) tube or intravenous fluid.

Heart transplant postoperative care

You will be asked to stay in the intensive care unit (ICU) for a few days. Then, transferred to a regular hospital room. You will most likely remain in the hospital for a week or two. The amount of time spent in the ICU and in the hospital varies from person to person.

After you leave the hospital, a team of doctors will monitor your health at your outpatient transplant center.

Monitoring after transplant

The frequency of monitoring is very close, usually causing many people to stay near the transplant center for the first three months. After that, follow-up visits are less frequent so it's not a hassle to go back and forth.

You will also be monitored for any signs or symptoms of rejection, such as shortness of breath, fever, fatigue, not urinating much, or weight gain. It is important to tell the team of doctors if you experience any signs or symptoms of rejection or infection.

In order to determine whether or not your body is rejecting a new heart, you will often have a heart biopsy in the first few months after a heart transplant. It is at this time that organ rejection is most likely to occur.

During a heart biopsy, the doctor inserts a tube into a vein in the neck or groin and directs it to the heart. The doctor will run a biopsy tool through a tube to remove a small sample of heart tissue, which is examined in a laboratory.

Long-term care after heart transplant

You will need to make some long-term adjustments after having a heart transplant, including:

• Take immunosuppressant drugs. These drugs help lower the activity of your immune system so that it doesn't attack the donor heart. You will be asked to take this medicine on a continuous basis but over time the risk of rejection will decrease so that the dose and amount of this drug can be reduced.
• Take other medications. Immunosuppressant drugs make you more susceptible to infection, so your doctor will prescribe antibacterial, antiviral, and antifungal medications.
• Lifestyle changes. Your doctor may give you instructions about your lifestyle, such as wearing sunscreen, quitting smoking, exercising, eating a healthy diet and being careful about activities to lower your risk of infection.
• Cardiac rehabilitation. These programs include exercise and physical exercise to help you improve your health and recuperate after a heart transplant. This complementary care is usually started before you are discharged from the hospital.

Follow all instructions given by your doctor. Make regular doctor visits for follow-up appointments, and tell your doctor if you have signs or symptoms of complications.