Heart transplant
Overview
A heart transplant is an
operation in which a diseased, failing heart is replaced with a healthier donor
heart. Heart transplant is a treatment that's usually reserved for people whose
condition hasn't improved enough with medications or other surgeries.
While a heart transplant is
a major operation, your chance of survival is good with appropriate follow-up.
Heart transplants are
performed when other treatments for heart problems haven't worked, leading to
heart failure. In adults, heart failure can be caused by:
A weakening of the heart
muscle (cardiomyopathy)
Coronary artery disease
Heart valve disease
A heart problem you're born
with (congenital heart defect)
Dangerous recurring abnormal
heart rhythms (ventricular arrhythmias) not controlled by other treatments
Failure of a previous heart
transplant
In children, heart failure
is most often caused by either a congenital heart defect or cardiomyopathy.
Another organ transplant may
be performed at the same time as a heart transplant (multiorgan transplant) in
people with certain conditions at select medical centers.
Multiorgan transplants
include:
Heart-kidney transplant.
This procedure may be an option for some people with kidney failure in addition
to heart failure.
Heart-liver transplant. This
procedure may be an option for people with certain liver and heart conditions.
Heart-lung transplant.
Rarely, doctors may suggest this procedure for some people with severe lung and
heart diseases if the conditions cannot be treated with only a heart transplant
or a lung transplant.
A heart transplant is not
right for everyone, however. You might not be a good candidate for a heart
transplant if you:
Are at an advanced age that
would interfere with the ability to recover from transplant surgery
Have another medical
condition that could shorten your life, regardless of receiving a donor heart,
such as a serious kidney, liver or lung disease
Have an active infection
Have a recent personal
medical history of cancer
Are unwilling or unable to
make lifestyle changes necessary to keep your donor heart healthy, such as not
drinking alcohol or not smoking
Ventricular assist devices
For some people who cannot
have a heart transplant, another option may be a ventricular assist device
(VAD). A ventricular assist device is a mechanical pump implanted in your chest
that helps pump blood from the lower chambers of your heart (ventricles) to the
rest of your body.
VADs are commonly used as
temporary treatments for people waiting for heart transplants. These devices
are increasingly being used as long-term treatments for people who have heart
failure but are not eligible for heart transplants. If a VAD doesn't help your
heart, doctors may sometimes consider a total artificial heart — a device that
replaces the ventricles of your heart — as an alternative short-term treatment
while you're waiting for a heart transplant.
Risks
Besides the risks of having
open-heart surgery, which include bleeding, infection and blood clots, risks of
a heart transplant include:
Rejection of the donor heart.
One of the most significant risks after a heart transplant is your body
rejecting the donor heart.
Your immune system may see
your donor heart as a foreign object and try to reject it, which can damage the
heart. Every heart transplant recipient receives medications to prevent
rejection (immunosuppressants), and as a result, the rate of rejection
continues to decrease. Sometimes, a change in medications will halt rejection
if it occurs.
To help prevent rejection,
it's critical that you always take your medications as prescribed and keep all
your appointments with your doctor.
Rejection often occurs
without symptoms. To determine whether your body is rejecting the new heart,
you'll have frequent heart biopsies during the first year after your
transplant. After that, you won't need biopsies as often.
During the biopsy, a tube is
inserted into a vein in your neck or groin and directed to your heart. A biopsy
device is run through the tube to take a tiny sample of heart tissue, which is
examined in a lab.
Primary graft failure.
With this condition, the most frequent cause of death in the first few months
after transplant, the donor heart doesn't function.
Problems with your arteries.
After your transplant, it's possible that the walls of the arteries in your
heart could thicken and harden, leading to cardiac allograft vasculopathy. This
can make blood circulation through your heart difficult and can cause a heart
attack, heart failure, heart arrhythmias or sudden cardiac death.
Medication side effects.
The immunosuppressants you'll need to take for the rest of your life can cause
serious kidney damage and other problems.
Cancer. Immunosuppressants
can also increase your risk of developing cancer. Taking these medications can
put you at a greater risk of skin and lip tumors and non-Hodgkin's lymphoma,
among others.
Infection.
Immunosuppressants decrease your ability to fight infection. Many people who
have heart transplants have an infection that requires them to be admitted to
the hospital in the first year after their transplant.
How you prepare
Preparations for a heart
transplant often begin weeks or months before you receive a donor heart.
Taking the first steps
If your doctor recommends a
heart transplant, you'll likely be referred to a heart transplant center for
evaluation. Or you can select a transplant center on your own. Check your
health insurance to see which transplant centers are covered under your plan.
When evaluating a heart
transplant center, consider the number of heart transplants a center performs
each year and the survival rates. You can compare transplant center statistics
using a database maintained by the Scientific Registry of Transplant
Recipients.
You should also check to see
if a transplant center offers other services you might need. These include
coordinating support groups, assisting with travel arrangements, helping you
find local housing for your recovery period or directing you to organizations
that can help with these concerns.
Once you decide on a center,
you'll need to have an evaluation to see if you're eligible for a transplant.
The evaluation will check to see if you:
Have a heart condition that
would benefit from transplantation
Might benefit from other,
less aggressive treatment options
Are healthy enough to
undergo surgery and post-transplant treatments
Will agree to quit smoking,
if you smoke
Are willing and able to
follow the medical program outlined by the transplant team
Can emotionally handle the
wait for a donor heart
Have a supportive network of
family and friends to help you during this stressful time
Waiting for a donor organ
If the transplant center
medical team determines that you're a good candidate for a heart transplant,
the center will put you on a waiting list. The wait can be long since there are
more people who need hearts than donors. Finding a donor depends on your size,
your blood type and how sick you are.
While you're on the waiting
list, your medical team will monitor your heart and other organs and adjust
your treatment as necessary. The team will help you learn to care for your
heart by eating well and being active.
.Immediately before your transplant surgery
A heart transplant usually
needs to occur within four hours of organ removal for the donor organ to remain
usable. As a result, hearts are offered first to a transplant center close by
and then to centers within certain distances of the donor hospital.
The transplant center will
provide you with a pager or cellphone to notify you when a potential heart is
available. You must keep your cellphone or pager charged and turned on at all
times.
Once you're notified, you
and your transplant team have limited time to accept the donation. You'll have
to go to the transplant hospital immediately after being notified.
As much as possible, make
travel plans ahead of time. Some heart transplant centers provide private air
transportation or other travel arrangements. Have a suitcase packed with
everything you'll need for your hospital stay, as well as an extra 24-hour
supply of your medications.
Once you arrive at the
hospital, your doctors and transplant team will conduct a final evaluation to
determine if the donor heart is suitable for you and if you're ready for
surgery. If your doctors and transplant team decide that either the donor heart
or surgery isn't appropriate for you, you might not be able to have the
transplant.
Heart transplant surgery.
Heart transplant surgery is
an open-heart procedure that takes several hours. If you've had previous heart
surgeries, the surgery is more complicated and will take longer
You'll receive medication
that causes you to sleep (general anesthetic) before the procedure. Your
surgeons will connect you to a heart-lung bypass machine to keep oxygen-rich
blood flowing throughout your body.Your surgeon will make an incision in your
chest. Your surgeon will separate your chest bone and open your rib cage so
that he or she can operate on your heart.
Your surgeon then removes
the diseased heart and sews the donor heart into place. He or she then attaches
the major blood vessels to the donor heart. The new heart often starts beating
when blood flow is restored. Sometimes an electric shock is needed to make the
donor hear beat properly.
You'll be given medication
to help with pain control after the surgery. You'll also have a ventilator to
help you breathe and tubes in your chest to drain fluids from around your lungs
and heart. After surgery, you'll also receive fluids and medications through
intravenous (IV) tubes.
After the procedure
You'll initially stay in the
intensive care unit (ICU) for a few days, then be moved to a regular hospital
room. You're likely to remain in the hospital for a week or two. The amount of
time spent in the ICU and in the hospital varies from person to person.
After you leave the
hospital, your transplant team will monitor you at your outpatient transplant
center. Due to the frequency and intensity of the monitoring, many people stay
close to the transplant center for the first three months. Afterward, the
follow-up visits are less frequent, and it's easier to travel back and forth.
You'll also be monitored for
any signs or symptoms of rejection, such as shortness of breath, fever,
fatigue, not urinating as much or weight gain. It's important to let your
transplant team know if you notice any signs or symptoms of rejection or
infection.
To determine whether your
body is rejecting the new heart, you'll have frequent heart biopsies in the
first few months after heart transplantation, when rejection is most likely to
occur. The frequency of necessary biopsies decreases over time
You'll need to make several
long-term adjustments after you have had your heart transplant. These include:
Taking immunosuppressants.
These medications decrease the activity of your immune system to prevent it
from attacking your donated heart. You'll take some of these medications for
the rest of your life.
Because immunosuppressants
render your body more vulnerable to infection, your doctor might also prescribe
antibacterial, antiviral and antifungal medications. Some drugs could worsen —
or raise your risk of developing — conditions such as high blood pressure, high
cholesterol, cancer or diabetes.
Over time, as the risk of
rejection decreases, the doses and number of anti-rejection drugs can be
reduced.
Managing medications,
therapies and a lifelong care plan. After a heart transplant,
taking all your medications as your doctor instructs and following a lifelong
care plan are vital.
Your doctor might give you
instructions regarding your lifestyle, such as wearing sunscreen, not using
tobacco products, exercising, eating a healthy diet and being careful to lower
your risk of infection.
Follow all of your doctor's
instructions, see your doctor regularly for follow-up appointments, and let
your doctor know if you have signs or symptoms of complications.
It's a good idea to set up a
daily routine for taking your medications so that you don't forget. Keep a list
of all your medications with you at all times in case you need emergency
medical attention and tell all your doctors what you take each time you're
prescribed a new medicine.
Cardiac rehabilitation.
These programs incorporate exercise and education to help you improve your
health and recover after a heart transplant. Cardiac rehabilitation, which you
might start before you're released from the hospital, can help you regain your
strength and improve your quality of life.
Results
Most people who receive a
heart transplant enjoy a good quality of life. Depending on your condition, you
may be able to resume many of your daily life activities, such as returning to
work, participating in hobbies and sports, and exercising. Discuss with your
doctor what activities are appropriate for you.
Some women who have had
heart transplants can become pregnant. However, talk to your doctor if you're
considering having children after your transplant. You'll likely need
medication adjustments before becoming pregnant, as some medications can cause
pregnancy complications.
Survival rates after heart
transplantation vary based on a number of factors. Survival rates continue to
improve despite an increase in older and higher risk heart transplant
recipients. Worldwide, the overall survival rate is more than 85% after one
year and about 69% after five years for adults.
What if your new heart
fails?
Heart transplants aren't
successful for everyone. Your new heart can fail for a number of reasons. Your
doctor might then recommend adjusting your medications or, in more extreme
cases, having another heart transplant.If additional treatment options are
limited, you might choose to stop treatment. Discussions with your heart
transplant team, doctor and family should address your expectations and
preferences for treatment, emergency care and end-of-life care.
Clinical trials
Coping and Support
It's normal to feel anxious
or overwhelmed while waiting for a transplant or to have fears about rejection,
returning to work or other issues after a transplant. Seeking the support of
friends and family members can help you cope during this stressful time.
Joining a support group for
transplant recipients provides the opportunity to talk with others who share
your experience can ease fears and anxiety.
Setting realistic goals and
expectations. Recognize that life after transplant might
not be the same as life before transplant. Having realistic expectations about
results and recovery time can help reduce stress.
Educating yourself.
Read as much as you can about your procedure and ask questions about things you
don't understand. Knowledge is empowering.
Diet and nutrition
After your heart transplant,
you may need to adjust your diet to keep your heart healthy and functioning
well. Maintaining a healthy weight through diet and exercise can help you avoid
complications such as high blood pressure, heart disease and diabetes.
A nutrition specialist
(dietitian) can discuss your nutrition and diet needs and answer any questions
you have after your transplant. Your dietitian will provide you with several
healthy food options and ideas to use in your eating plan. Your dietitian's
recommendations may include:
Eating plenty of fruits and
vegetables each day
Eating whole-grain breads,
cereals and other grains
Drinking low-fat or fat-free
milk or eating other low-fat or fat-free dairy products, to help maintain
enough calcium in your body
Eating lean meats, such as
fish or poultry
Maintaining a low-salt diet
Avoiding unhealthy fats,
such as saturated fats or trans fats
Avoiding grapefruit and
grapefruit juice due to its effect on a group of immunosuppressant medications
(calcineurin inhibitors)
Avoiding excessive alcohol
Staying hydrated by drinking
adequate water and other fluids each day
Following food safety
guidelines to reduce the risk of infection
Exercise
After your heart transplant,
your doctor and treatment team may recommend that you make exercise and
physical activity a regular part of your life to continue to improve your
overall physical and mental health.
Exercising regularly can
help you control your blood pressure, reduce stress, maintain a healthy weight,
strengthen your bones and increase your physical function.
Your treatment team will
create an exercise program designed to meet your individual needs and goals.
You'll participate in cardiac rehabilitation to help improve your endurance,
strength and energy. Cardiac rehabilitation incorporates education and exercise
to help you improve your health and recover after your heart transplant.
Your exercise program may
include warm-up exercises such as stretching or slow walking. Your treatment
team may suggest physical activities such as walking, bicycling and strength
training as part of your exercise program. Specialists in the treatment team
will likely recommend you cool down after you exercise, perhaps by walking
slowly. Discuss with your treatment team what activities may be appropriate for
you.
Take a break from exercising
if you feel tired. If you feel symptoms such as shortness of breath, nausea,
irregular heart rate or dizziness, stop exercising. If your symptoms don't go
away, contact your doctor right away.
Jan Ricks Jennings, MHA,
LFACHE
Senior Consultant
Senior Management Services,
LLC
JanJenningsBlog.Blogspot.com
412.913.0636 Cell
724.733.0508 Office
October 23, 2021
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