Procedure for Heart Transplant Procedure

What to Expect – Heart Transplant Procedure

Heart transplantation is a complex surgical procedure performed for conditions like cardiac arrhythmias, severe chronic coronary artery disease, and end-stage heart failure when other medical or surgical treatments have failed. The heart transplant procedure is a complex procedure requiring a lot of pre procedure checks and preparation and hence the eligibility for heart transplant needs to be thoroughly checked.

We will understand the various aspects of the heart transplant procedure.

Preparations Before the Procedure

The cardiologist evaluates a lot of information to determine the eligibility for heart transplant:

1. Diagnostic Evaluation: Blood tests to determine the complete health status of the recipient are and a good match donor is determined. Other diagnostic tests include dental examination, pulmonary function test, radiological /ultrasound examinations like x-ray, ultrasound, and computerized tomography. In females, gynecological screening, Pap smear, and mammography are done.
2. Psychological and Social Screening: Factors like family support, stress and financial status, is evaluated well in advance.
3. Other Evaluation: Immunization status is also screened in advance as a precaution to prevent infections.

Heart Transplant Surgery

There are a few things one needs to know about what actually happens during the heart transplant surgery. Some of them are as follows:

• Heart Transplant procedure requires an inpatient admission. This inpatient length of stay depends on the patient’s condition.
• Prior to the heart transplantation the patient is advised to change their clothes and wear a hospital gown and remove any ornaments which might interfere in the procedure.
• An intravenous (IV) line/catheter is placed to administer medicine and for monitoring the heart rate and blood pressure.
• Excess hair is removed from the surgical site. The site of the procedure is disinfected with an appropriate antiseptic prior to the surgical incision from the Adam's apple up to the naval.
• Heart Transplant is done under General anesthesia.
• Patient is put on ventilatory support
• The procedure requires continuous and constant monitoring of the heart rate, blood pressure and blood oxygen levels of the patient
• A Cardiopulmonary bypass machine (heart-lung machine) is set up.
• With the support of the cardiopulmonary bypass machine, the unhealthy/diseased heart is removed.
• Simultaneously, the donor's heart is placed in the body and blood vessels are connected.
• When the transplant procedure is completed, the blood circulating from the cardiopulmonary bypass machine is allowed back to the heart and the machine and tubes are disconnected and removed
• The sternum (breastbone) is joined back together and tied up with wires.
• Small tube is attached to the heart for draining the excess fluid from it.
• The heart is defibrillated/shocked to restart the heartbeat.
• As the heart restarts it is further examined for its functioning.

Heart Transplant: Post-operative Care

The post - operative care is crucial after the heart transplant. Following things need to be kept in mind:

1. During the Hospital Stay
   • After the transplant, the patient is shifted to the ICU with continuous monitoring of the vital parameters like blood pressure, heart rate, breathing rate, and blood oxygen level
   • Assisted breathing is facilitated.
   • Regular and frequent blood tests are done to check the functioning of the new heart.
   • Heart transplant medications including immunosuppressants are prescribed to lower our immune system's response against foreign body/substance. Immunosuppressants lower the chances of the transplant organ rejection. Some immunosuppressant prescribed are:
     • Prednisone
     • Cyclosporine
     • Sirolimus
     • Tacrolimus
     • Methotrexate
2. Post Discharge Care
   • After discharge, it is advised that the operated area if kept clean and dry.
   • A regular follow- up is advised.
   • A person who has undergone a heart transplant should seek immediate medical attention if the following symptoms are seen:
     • Difficulty in breathing
     • Swelling/Bleeding/Redness on the operated site
     • Increased pain around incision
     • Fever
     • Chills