Heart transplant

Definition

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

Description

Heart transplant is the fourth most common transplant operation in the U.S., with over 2,200 cases per year. Cornea, kidney and liver transplants are the most common. A healthy heart is obtained from a donor who is brain dead but on life-support. The healthy heart is put into a special solution that preserves the organ.

The patient is put into a deep sleep with general anesthesia, and a cut is made through the breast bone. The patient's blood is circulated through a heart-lung bypass machine to keep the blood oxygen-rich. The patient's diseased heart is removed and the donor heart is stitched in place. The heart-lung machine is disconnected. Blood flows through the transplanted heart.

Indications

A heart transplant may be recommended for:

Heart 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

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.

Expectations after surgery

Heart transplant prolongs the life of a patient who would otherwise die. About 80% of heart transplants are alive 2 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. The downside of these drugs is that they weaken the body's natural defense against infection.

Convalescence

The recovery period is about 6 weeks. The patient must move the legs often to reduce the risk of deep venous thrombosis. The stitches or clips are removed about 1 week after surgery.

References

Zipes DP, Libby P, Bonow RO, Braunwald E, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, 7th ed. St. Louis, Mo; WB Saunders; 2005: 641-651.

Illustrations

Heart, section through the middle

Heart, front view

Normal anatomy of the heart

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