Heart transplant

Heart transplant

Definition

Heart transplantation is a surgical procedure to remove a damaged or diseased heart and replace it with a healthy donor heart.

Alternative Names

Cardiac transplant; Transplant - heart

Indications

A heart transplant may be recommended forheart failure caused by:

• Coronary artery disease
• Cardiomyopathy (disease of the heart muscle)
• Heart valve disease with congestive heart failure
• Severe heart disease present at birth
• Life-threatening abnormal heart beats that do not respond to other therapy

Heart transplant surgery is not recommended for patients who have:

• Kidney, lung, or liver disease
• Insulin-dependent diabetes with poor function of other organs
• Other types of blood vessel disease of the neck and leg
• Other life-threatening diseases

Convalescence

The recovery periodis about6 weeks. The patient must move the legs often to reduce the risk of deep venous thrombosis. The stitches or clips are removed about1 week after surgery.

Expectations after surgery

Heart transplant prolongs the life of a patient who would otherwise die. About 80% of heart transplants are alive2 years after the operation. The main problem, as with other transplants, is graft rejection. If rejection can be controlled, the patient's survival can be increased to over 10 years.

Drugs that prevent transplant rejection must be taken for the rest of the patient's life. Normal activities can resume as soon as the patient feels well enough and after consulting with the doctor. However, vigorous physical activities should be avoided.

The major problems are the same for all major organ transplants:

• Finding a donor
• Fighting the rejection effect
• The cost of the surgery
• Avoiding infection
• Avoiding blocked blood vessels in the transplanted organ

Finding a donor can be difficult. In heart transplantation, the healthy heart must come from a person who recently died or is on life-support and is brain dead. This is different than a kidney transplant, because a kidney may be donated by a living person.

Timing is very important because there is no good way to keep a donor heart alive for long periods of time. A person in need of a heart transplant may be kept alive on artificial heart devices for longer and longer periods of time. However, artificial hearts also have major risks. While some of these devices are fully approved, others are still considered experimental.

Fighting rejection is an ongoing process. The body's immune system considers the transplanted organ an infection and fights it. For this reason, organ transplant patients must take drugs such as cyclosporine and corticosteroids that suppress the body's immune response. Thedownside of these drugs is that they weaken the body's natural defense againstinfection.

Risks

Risks for any anesthesia are:

• Reactions to medications
• Problems breathing

Risks for any surgery are:

• Bleeding
• Infection

Heart transplants carry major risks. There is a greater risk of infection because of the drugs that must be taken to prevent transplant rejection. Call your doctor if there are signs of infection (redness, drainage, fever) or if there is a general worsening of health.

References

Heart, section through the middle

Heart, front view

Normal anatomy of the heart

Heart transplant - series

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