Heart Transplant Surgery

Medically reviewed by Debra Sullivan, PhD, MSN, RN, CNE, COI on February 8, 2016Written by Erica Roth

What Is a Heart Transplant?

A heart transplant is a surgical procedure used to treat the most serious cases of heart disease. This is a treatment option for people who are in the end stages of heart failure and for whom medication, lifestyle changes, and less invasive procedures haven't succeeded. People must meet specific criteria to be considered a candidate for the procedure.

Candidacy for Heart Transplants

Heart transplant candidates are those who’ve experienced heart disease or heart failure due to a variety of causes, including:

  • a congenital defect
  • coronary artery disease
  • a valve dysfunction or disease
  • a weakened heart muscle, or cardiomyopathy

Even if you have one of these conditions, there are still more factors that are used to determine your candidacy, such as the following:

  • Your age will be considered. Most prospective heart recipients must be under 65 years old.
  • Your overall health will be considered. Multiple organ failure, cancer, or other serious medical conditions may take you off a transplant list
  • Your attitude will be considered. You must commit to changing your lifestyle. This includes exercising, eating healthy, and quitting smoking if you smoke.

If you're determined to be an ideal candidate for a heart transplant, you'll be put on a waiting list until a donor heart that matches your blood and tissue type is available.

Not everyone on the waiting list will survive until a heart is found. An estimated 2,000 donor hearts become available in the United States each year. Yet, approximately 3,000 people are on a heart transplant waiting list at any given time, according to the University of Michigan. When a heart is found for you, surgery is performed as soon as possible while the organ is still viable. This is usually within four hours.

What Is the Procedure?

Heart transplant surgery lasts for approximately four hours. During that time, you'll be placed on a heart-lung machine to keep blood circulating throughout your body. Your surgeon will remove your heart, leaving the pulmonary vein openings and the back wall of the left atrium intact. They’ll do this to prepare you to receive the new heart.

Once your doctor stitches the donor heart into place and the heart begins beating, you'll be removed from the heart-lung machine. In most cases, the new heart will begin to beat as soon as blood flow is restored to it. But, sometimes an electric shock is required to prompt a heartbeat.

What Is Recovery Like?

After your surgery is finished, you’ll be taken to the intensive care unit (ICU). You'll be constantly monitored, given pain medication, and outfitted with drainage tubes to remove excess fluid from your chest cavity.

Recovery from a heart transplant can be a long process, spanning up to six months for many people. After the first day or two after the procedure, you'll most likely be moved from the ICU. However, you'll remain in the hospital as you continue to heal. Hospital stays range from one to three weeks, based on your individual rate of recovery.

You'll be monitored for infection, and your medication management will begin. Anti-rejection medications are crucial to ensure that your body doesn't reject your donor organ. You may be referred to a cardiac rehabilitation unit or center to help you adjust to your new life as a transplant patient.

Follow-Up After the Surgery

Frequent follow-up appointments are crucial to the long-term recovery and management of a heart transplant. Your medical team will perform blood tests, heart biopsies through catheterization, and echocardiograms on a monthly basis for the first year after the operation to ensure that your new heart is functioning properly. Your immunosuppressant medications will be adjusted if needed, and you'll be asked if you've suffered from any of the possible signs of rejection, including:

  • a fever
  • fatigue
  • shortness of breath
  • weight gain due to fluid retention
  • reduced urine output

Report any changes in your health to your cardiac team so that your heart function can be monitored if required. Once a year has passed after the transplant, your need for frequent monitoring will decline but you'll still need yearly testing.

Women of childbearing age should consult their cardiologist before starting a family. Pregnancy is safe for people who’ve had a heart transplant. However, expectant mothers who have pre-existing heart disease or who’ve had a transplant are considered high risk and may experience a greater chance of pregnancy-related complications and a higher risk of organ rejection.

What Is the Outlook?

Receiving a new heart can improve your quality of life considerably, but you have to take good care of it. In addition to taking daily anti-rejection medications, you'll need to follow a heart-healthy diet and lifestyle as prescribed by your doctor. This includes not smoking and exercising on a regular basis if you're able.

Survival rates for people who’ve had a heart transplant vary according to their overall health status, but averages remain high. Rejection is the main cause for a shortened life span. The Mayo Clinic estimates that the overall survival rate in the United States is about 88 percent after one year and 75 percent after five years.

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