What are the other Names for the Procedure?
- Cardiac Transplantation
- Heart Grafting
- Transplantation of Heart
What is Heart Transplantation surgical procedure?
Heart Transplantation is a procedure that surgically removes a damaged or diseased heart and replaces it with a healthy heart from a donor.
What part of the Body does the Procedure involve?
A Heart Transplantation involves the damaged or diseased heart and a heart from a donor.
Why is the Heart Transplantation surgical procedure Performed?
A Heart Transplantation is performed for the following reasons:
- Heart failure due to coronary artery disease
- Heart failure due to cardiomyopathy
- Heart failure due to severe congenital heart disease
- Valvular heart disease associated with congestive heart failure
What are some Alternative Choices for the Procedure?
In patients with severe heart failure, a Heart Transplantation remains the gold standard treatment option.
What are the Recent Advances in the Procedure?
Artificial heart placement has been the recent advancement in this field.
What is the Cost of performing the Heart Transplantation surgical procedure?
The cost of Colostomy procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.
In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.
When do you need a Second Opinion, prior to the Procedure?
- It is normal for a patient to feel uncomfortable and confused by the information regarding Heart Transplantation and on what needs to be done
- If the patient needs further reassurance or a second opinion, a physician will almost always assist and also recommend another physician, if required
- They can also choose to approach another physician independently. Besides, if the procedure has many alternatives, the patient may take a second opinion to understand and choose the best one
What are some Helpful Resources?
Complete Guide to Symptoms, Illness & Surgery; Written by H Winter Griffith, M.D.; Revised and updated by Stephen Moore, M.D. and Kenneth Yoder, M.D.; The Berkley Publishing Group, 5th Edition, New York, 2006
Prior to Heart Transplantation surgical procedure:
How is the Heart Transplantation surgical procedure Performed?
A Heart Transplantation procedure involves 3 steps:
- In this step, the heart is removed from the donor
- Typically, donors are those who are brain dead (i.e., when the brain has suffered an irreversible injury, but all other organs are functioning well with medications and life support measures)
- A cardiac transplant team of physicians, nurses, and technicians, removes the donor’s heart (after traveling to the hospital of the donor)
- The heart is then transported on ice, to keep it alive until it can be implanted
- It has to be implanted within 6 hours and so, the organ is often flown by an airplane, helicopter, or taken by an ambulance, depending on the proximity to the recipient's hospital
- In this step, the recipient's damaged heart is removed
- A skin incision is made on the chest. The incision is deepened and the chest opened
- The damaged heart removal may sometimes be difficult depending on whether the recipient has had a previous heart surgery (as is often the case) or not
- If there has been previous surgery, cutting through the scar tissue may prolong and complicate removal of the heart
- In this step, the donor heart is implanted
- All the blood vessels entering and leaving the heart are connected with sutures
- Once the connection is established with all the blood vessels, the chest is then closed in layers with stitches
Where is the Procedure Performed?
A Heart Transplantation procedure is performed in a hospital.
Who Performs the Procedure?
A cardiovascular surgeon performs a Heart Transplantation procedure.
How long will the Procedure take?
The procedure to replace the heart, may take anywhere between 6 to 8 hours.
What do you need to tell your Physician before the Procedure?
It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the surgical procedure and helps avoid unnecessary complications.
- Provide a complete list of medications you are currently, taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
- If you are allergic to any specific medication or food items
- If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
- If you or your family members, have a history of bleeding disorders, or if there is a tendency to bleed more than normal
- If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
- If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
- If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
- A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.
What Preparations are needed, prior to the Procedure?
- The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are being currently taken
- Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time, before the procedure is performed
- Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
- Normally local anesthesia is not used; however do inform the physician if you are allergic to any local anesthetics, lidocaine, etc.
- Avoid application of any cosmetics, deodorant, or topical medicines on the area, prior to the procedure
- It is advisable to quit smoking and the use of any nicotine based products, for a while, before the surgery
- Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
- The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
- For persons suffering from diabetes, it is important that the blood sugar stays within the normal range; if not their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines
What is the Consent Process before the Procedure?
A physician will request your consent for the Heart Transplantation procedure using an Informed Consent Form.
Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.
You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.
What Tests are needed, before the Heart Transplantation surgical procedure?
Prior to a Heart Transplantation procedure, the individual may have to undergo certain tests, such as:
- Routine blood and urine analysis
- Chest x-ray
- Immune system study
- Electrocardiography (ECG)
- Ultrasound imaging
- Stress test
- Cardiac catheterization
The physician may suggest further tests depending on the health of the individual and their medical history.
What are some Questions for your Physician?
Some of the basic questions that you might ask your physician are as follows:
- What is a Heart Transplantation?
- Why is this procedure necessary? How will it help?
- How soon should I get it done? Is there an emergency?
- Who are the medical personnel involved in this procedure?
- Where is the procedure performed?
- What are the risks while performing the procedure?
- What are the complications that might take place, during recovery?
- How long will it take to recover? When can I resume normal work?
- Are there any lifestyle restrictions or modifications required, after the procedure is performed?
- Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
- Is there any medication that needs to be taken for life, after the procedure?
- How many such procedures have you (the physician) performed?
- What are the costs involved?
During the Heart Transplantation surgical procedure:
What kind of Anesthesia is given, during the Procedure?
General anesthesia is administered for a Heart Transplantation procedure.
How much Blood will you lose, during the Procedure?
A Heart Transplantation surgery is a highly invasive procedure. The blood loss could sometimes be substantial; hence, blood products should always be readily available for the procedure.
What are the possible Risks and Complications during the Heart Transplantation surgical procedure?
There are general factors that increase the risk of getting complications during surgery and they include:
- Obesity: Generally greater the degree of obesity, greater is the surgical risk
- Smoking: Longer the smoking history (in pack years smoked), greater the surgical risk
- Advancing age
- Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
- Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
- Poorly functioning liver, as evidenced by increased blood liver function tests
- Hypertension (increased blood pressure), especially if it is poorly controlled
- Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
- Poor lung function, as evidenced by abnormal lung function tests
- History of bleeding disorders
- Longstanding illness, such as autoimmune disorders, chronic infections
- Poor immune system due to a variety of causes
The possible risks or complications that may arise during the surgery are:
- Excessive bleeding
- Infection in the surgical wound
- Anesthetic complications
- Donor heart rejects its new host
- Contraction of the arteries connected to the donor heart
- Failure of new donor heart to pump normally (primary graft dysfunction)
What Post-Operative Care is needed at the Healthcare Facility after the Heart Transplantation surgical procedure?
- After the surgical procedure, the patient shall be sent to a cardiovascular intensive care unit
- The patient’s blood pressure, heart rate, and respiration cycle, will be closely monitored
After the Heart Transplantation surgical procedure:
What are the possible Risks and Complications after the Heart Transplantation surgical procedure?
Post Heart Transplantation procedure, the following complications may arise:
- Infection in the surgical wound
- Donor heart rejects its new host
- Failure of new donor heart to pump normally (primary graft dysfunction)
- Heart rhythm abnormalities
- Heart rate abnormalities
- Complications related to immuno-suppressant medications that are started after heart transplantation
What is the Prognosis after the Surgery?
The prognosis depends upon various factors, like age of the individual, associated medical conditions (that they may have), the donor heart, and immune system of the recipient.
When do you need to call your Physician?
Do contact your physician if you notice any of the following symptoms:
- Worsening pain and swelling within the surgical wound
- Bleeding or fluid drainage around the surgical wound
- The occurrence of any symptom that causes uneasiness, such as nausea, vomiting, and constipation
- Abnormal swelling
- Asymmetrical heartbeat
- Signs of an infection
- Muscle aches
- Feeling sick
- Complications associated with prescription medications used in treatment
What Post-Operative Care is needed at Home after the Heart Transplantation surgical procedure?
At home, the following post-operative care is recommended, after a Heart Transplantation procedure:
- Avoid all activities that are physically strenuous for about 6 weeks, or as advised by your physician
- Resume regular/daily activities, as early as possible (under advice by the physician). This aids in a faster recovery
- Use a heat pad or warm compress to relieve pain due to the incision
- Avoid taking baths until the surgical wound is completely healed. Resume showering and keep the wound clean and dry, after advise from physician
- Take stool softeners to prevent constipation
- Take antibiotic medication to help combat or prevent infection, as prescribed by the physician
- Take immunosuppressant medications to reduce the possibility of rejection, as prescribed by the physician
- Avoid taking nonprescription medications
- Complete the course of prescribed medication under advice of the physician
- Elevate legs while resting to prevent the formation of blood clots and reduce the possibility of swelling
- Avoid sex till complete healing has taken place, or follow physician’s advise
How long does it normally take to fully recover, from the Procedure?
It may take anywhere between 6 to 8 weeks to recover from the procedure.
What happens to tissue (if any), taken out during the Procedure?
The tissue is taken for further examination and is later disposed, as per the standard medical procedure.
When should you expect results from the pathologist regarding tissue taken out, during the Procedure?
- The tissue removed is processed in the laboratory under a pathologist's supervision
- The slide(s) are prepared once the tissue is processed, and this is examined by a pathologist and a pathology report issued
- Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time
Who will you receive a Bill from, after the Heart Transplantation surgical procedure?
It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.
Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:
- The hospital
- An anesthesiologist
- Cardiovascular surgeon
The patient is advised to inquire and confirm the type of billing, before the Heart Transplantation procedure is performed.
Thanks and Gratitude:
We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.
Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA