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Heart transplant
Description
A heart transplant is surgery to remove a damaged or diseased heart and replace it with a healthy donor heart.
Finding a donor heart can be difficult. The heart must be donated by someone who is brain-dead but is still on life support. The donor heart must be matched as closely as possible to your tissue type to reduce the chance that your body will reject it. You are put into a deep sleep with general anesthesia, and a cut is made through the breastbone. Your blood flows through a heart-lung bypass machine while the surgeon works on your heart. This machine does the work of your heart while your heart is stopped, and supplies your body with blood and oxygen. Your diseased heart is removed and the donor heart is stitched in place. The heart-lung machine is disconnected. Blood flows through the transplanted heart. Tubes are inserted to drain air, fluid, and blood out of the chest for several days, to allow the lungs to fully reexpand. In some cases, the surgeon will not remove the old heart, but will put the new heart on top of it (heterotopic transplant).
Risks
Risks from any anesthesia are: Reactions to medications Problems breathing Risks from any surgery are:
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Bleeding Infection Risks of transplant include: Blood clots (deep venous thrombosis) Damage to the kidneys, liver, or other organs from anti-rejection medications Development of cancer from the drugs used to prevent rejection Heart attack or stroke Heart rhythm problems High cholesterol levels, diabetes, and bone thinning from the use of rejection medications Increased risk for infections due to anti-rejection medications Rejection of the heart Severe coronary artery disease Wound infections
Outlook (Prognosis)
You should expect to stay in the hospital for 7 to 21 days after a heart transplant. The first 24 to 48 hours will likely be in the intensive care unit (ICU). During the first few days after a transplant, you will need close follow-up to make sure that you do not get an infection and your heart is working well. The recovery period is about 6 months. Often, your transplant team will ask you to stay fairly close to the hospital for the first 3 months. You will need to have regular check-ups with blood tests, x-rays, and echocardiograms for many years. Fighting rejection is an ongoing process. The body's immune system considers the transplanted organ an infection
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and fights it. For this reason, organ transplant patients must take drugs that suppress the body's immune response. Taking medicines and following your doctor's instructions carefully is very important to preventing rejection. Biopsies of the heart muscle are often done every month during the first 6 to 12 months after transplant, and then less often after that. This helps the doctor determine if your body is rejecting the new heart, even before you have symptoms. You must take drugs that prevent transplant rejection for the rest of your life. You will need to understand how to take these medications, and know their side effects. You can go back to your normal activities as soon as you feel well enough, and after talking with your doctor. However, avoid vigorous physical activity. To make sure that you do not develop coronary disease after a transplant, you will have cardiac catheterization every year.
Outlook (Prognosis)
Heart transplant prolongs the life of patients who would otherwise die. About 80% of heart transplant patients are alive 2 years after the operation. At 5 years, 70% of people will still be alive after a heart transplant. The main problem, as with other transplants, is rejection. If rejection can be controlled, survival increases to over 10 years.
Alternative Names
Cardiac transplant; Transplant - heart; Transplantation - heart
References
Bernstein D. Pediatric Heart and Heart-Lung Transplantation. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 18th Ed. Philadelphia, Pa: Saunders Elsevier; 2007: chap 443. McCarthy PM. Surgical management of heart failure. In: Libby P, Bonow RO, Mann DL, Zipes DP, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 8th ed. Philadelphia, Pa ; Saunders Elsevier; 2007: chap 27. Costanzo MR, Dipchand A, Starling R, Anderson A, Chan M, Desai S, et al. International Society of Heart and Lung Transplantation Guidelines. The International Society of Heart and Lung Transplantation Guidelines for the care of heart transplant recipients. J Heart Lung Transplant. 2010;29(8):914-956. Jessup M, Abraham WT, Casey DE, Feldman AM, Francis GS, Ganiats TG, et al. 2009 focused update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation. Circulation. 2009; 119(14):1977-2016.
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