HEART TRANSPLANT: WHEN AND HOW IT IS DONE

Your heart pumps blood to your vital organs and the rest of your body. Many consider it as the single most important body organ. Yet thousands of patients are on the heart transplant waiting list every year because of heart failure.

A Heart Transplant is an operation in which a diseased heart is replaced with a fully functioning, healthier heart from a donor. A heart transplant is usually a last resort treatment when medication and other surgeries have failed.

Success rates and life expectancy of a heart transplant are promising when necessary lifestyle changes are made. Keep reading to learn more about heart transplant, how it’s done, and how it’s like to live with a transplanted heart.

What Is A Heart Transplant?

A heart transplant, also known as cardiac transplantation, is a necessary surgical procedure to remove a diseased heart and replace it with a healthy one from a transplant donor.

The first-ever human-to-human heart transplant was performed by South African cardiac surgeon Christiaan Barnard utilizing the techniques developed by American surgeons Norman Shumway and Richard Lower.

Most heart transplants treat end-stage heart failure, wherein your heart is severely damaged. Healthcare professionals recommend this when other treatments fail, and your life is at risk because of a failing heart.

A heart transplant is the established gold standard treatment for patients with end-stage heart failure.

Survival rates and functional status are often excellent after a heart transplant as compared to continuing medical therapy.

Who Needs A Heart Transplant?

In end-stage heart failure, your heart muscles are severely damaged and fail to pump blood to the rest of your body. Cardiac treatment and medication are no longer effective in most cases.

In both adults and children, conditions that might result in heart failure and require a heart transplant include:

• Coronary Heart Disease: This disease results from fatty substance build-up in the arteries supplying your heart. It causes an obstruction that disrupts the blood flow to your heart, progressively weakening it.
• Congenital Heart Disease: A birth defect that causes various problems with your heart structure. It alters the way the blood flows through your heart and affects its function.
• Cardiomyopathy: This is a disease of the heart muscles. The walls of your heart are thickened and stiff, making it harder for it to pump blood efficiently.
• Arrhythmia: Also known as irregular heartbeat, arrhythmia is the change in the speed or pattern of your heartbeat. While most cases are uneventful, it’s potentially dangerous if neglected.
• Heart Valve Disease: When one or more of your heart valves don’t work correctly, it can weaken your heart and affect its ability to pump blood.

Heart transplantation is the treatment of choice for severely advanced heart failure. A new, healthy heart can restore proper circulation in your body and improve your overall quality of life.

Who Is Eligible For A Heart Transplant?

Almost 700,000 people are affected by cardiac diseases every year. For many people with advanced heart disease, heart replacement surgery is the only hope to improve the quality of life.

However, not everyone is a suitable candidate for a heart transplant. If you have heart disease, you’ll need to undergo an extensive evaluation by a heart transplant team and pass specific criteria.

• Blood tests: Blood type and other blood examinations are essential in finding a suitable donor match and preventing the risk of organ rejection.
• Diagnostic tests: Tests like X-rays, ultrasound, and pulmonary function tests assess your overall health to ensure your body can handle the heart transplant procedure.
• Psychological exam: A psychologist evaluates anything affecting your mental health. Psychological issues can stress your body and affect the outcome of your transplant.

Your transplant team has to consider all findings and results to determine if you are eligible for heart transplant surgery. You may not be a good candidate if you fall under the following conditions:

• Advanced age
• Alcohol or drug abuse
• Current or recurrent infection
• Medical history of cancer
• Severe liver, lung, or kidney disease
• Unwilling to make necessary lifestyle changes

How Is A Heart Transplant Donor Selected?

Heart transplant lists are different from regular transplant waiting lists. Unlike other organ transplant procedures, a donor must be declared brain-dead but still on life support to donate the heart.

Your transplant team must establish compatibility between you and your potential donor. Traditional cardiac donor selection criteria typically include:

• Age: Transplant centers typically require a donor to be at least 55 years old. Age is an essential factor in determining a better long-term outcome.
• Medical History: Your heart donor should not have any history of chest trauma or any cardiac disease. Other medical conditions determined by your heart transplant team may also disqualify a potential donor.
• Heart Health: All potential heart donors undergo echocardiographic examination, an imaging procedure that evaluates the heart’s movement and checks its function. Your donor should have a healthy, well-functioning heart.
• Compatibility: The heart donor must undergo extensive testing to ensure donor-recipient compatibility.

A successful heart transplant depends on the evaluation of your transplant team. If your donor's heart qualifies and is available for the transplant, your procedure must occur within 4 hours after receiving the heart.

How Is A Heart Transplant Done?

Heart transplant surgeries typically take up to 4 to 5 hours.

Nurses on your transplant team will start an intravenous (IV) line and add catheters to monitor your heart and blood pressure during a heart transplant surgery.

An anesthesiologist administers general anesthesia to keep you in a deep sleep for the operation. Your transplant surgeon then sterilizes the surgical site and creates an incision down the center of your chest.

To reach your heart, they cut your breastbone in half. Your large vessels will be connected to a heart-lung machine. This machine reroutes the blood away from the heart. It artificially pumps the blood in the circulation while bypassing the heart (think of it as a large artificial heart connected to your circulation).

Your surgeon will then remove your diseased heart and plant the donor heart into place. They must carefully reattach the blood vessels and ensure there are no leaks.

In some cases, your surgeon stimulates the transplanted heart to beat with electric shock paddles.

There is a short monitoring period to make sure the new heart is working correctly, and no leaking occurs. Afterward, your breastbone is closed and skin is sutured.

Recovery After A Heart Transplant

Once your new, healthy heart has been successfully transplanted, they will move you to the intensive care unit (ICU). Your transplant team will monitor you constantly for pressure reading, oxygen levels, and breathing rate.

You may require a ventilator (breathing machine) to support you until you can breathe on your own.

Heart transplant surgery requires a hospital stay of around 7 to 14 days, depending on your condition. If needed, they may refer you to a cardiac rehabilitation center. There, nurses, physical therapists, and respiratory therapists will help you adjust to life with a new heart.

Your doctor will prescribe pain medication and anti-rejection medicines. Anti-rejection medicines prevent your immune system from rejecting the donor’s heart.

It’s crucial that you consistently follow the prescribed medication and dosage to prevent adverse effects.

During the first days of home recovery, you will need to take some time off from work and avoid driving and strenuous activities until your doctor gives you the OK. Full recovery from a heart transplant can take up to 6 months or longer.

The road to recovery may be long and tiring but, with time, you’ll be able to live a healthy and happy life with your new heart.

Risks Of A Heart Transplant

A heart transplant is a complex and risky procedure. Although not a common occurrence, some complications can impact the outcome of your transplant surgery.

Rejection

Your immune system might see the transplanted heart as a foreign body, just like a bacteria or virus. If that happens, it can try to attack it. As a result, this can damage and reject the transplanted heart.

Heart biopsies are one of the diagnostic tests done beforehand to prevent such cases. It can determine compatibility between the transplant recipient and donor to reduce the risk of rejection.

After cardiac transplant surgery, you will receive immunosuppressants to prevent rejection. These are anti-rejection medicines to suppress your immune system and allow it to accept your new heart.

Cardiac Allograft Vasculopathy (CAV)

CAV can limit long-term survival after heart transplantation. It’s the thickening of the blood vessels in your heart, leading to impaired function and damage. Risk factors of CAV include smoking, coronary artery disease, rejection, and diabetes, among others.

Early diagnosis of CAV is essential for treatment and better outcomes.

Primary Graft Failure (PGF)

PGF is usually a complication that occurs in the immediate postoperative period after a heart transplant. The transplanted heart doesn't function properly and fails to meet the circulatory requirements of your body.

Thorough matching of transplant donors and recipients is critical in preventing PGF.

Cancer

Malignancies are a significant complication that affects both adults in children. Although data is scarce, immunosuppressants like cyclosporine and tacrolimus have been associated with post-transplant malignancies.

The risk factors of developing cancer after a heart transplant are the same as in the non-transplant population.

Infections

As with all surgical procedures, infection is a potential risk of a heart transplant. The immunosuppressants can weaken the efficiency of your immune system and its ability to fight bacteria and viruses.

Long-Term Results

Heart transplantation shows high life expectancy rates, with almost 80% of patients showing no limitations 3 years after their operations.

Worldwide, the survival rates after a heart transplant are over 85% after 1 year and almost 70% after 5 years.

Heart transplantation has become a treatment of choice for patients with advanced heart failure. With time, the majority of the patients live with a healthy heart and little to no symptoms.

Frequently Asked Questions (FAQs)

Can you live 20 years with a heart transplant?

Evidence suggests that the average life expectancy after a heart transplant is around 10 to 15 years, with a relatively high quality of life. Some have even survived more than 25 years.

Can a female heart be transplanted into a male? 

Transplant surgeons prioritize donors of the same sex. Donor organs from opposite sexes are used only in case of extreme emergency.

What disqualifies you from a heart transplant? 

Advanced age, current infections, history of cancer, and other medical conditions are some of the factors that may automatically disqualify you from being a potential transplant candidate.

What can you not eat after a heart transplant?

The nutritionist on your transplant team will likely recommend a healthy diet plan consisting of low-fat and low salt meals. You may need to avoid raw seafood and undercooked meat. Instead, go for whole-grain bread, fruits, and vegetables.

How old can a heart donor be?

There are no restrictions as to the age of heart donors. Hearts from newborns to 80-year-old individuals have been successfully transplanted.

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References

• Heart Transplant | Cardiac Surgery | Michigan Medicine | University of Michigan
• Long-term outcome following heart transplantation: current perspective
• Cardiac allograft vasculopathy: a review
• Cardiovascular Therapeutics: Cardiac Transplantation and Circulatory Support Devices
• Primary Graft Failure after Heart Transplantation
• Malignancies After Heart Transplant
• Heart Transplant Survival/Life Expectancy
• Heart Transplant
• Heart Transplant
• Heart Transplant | NHLBI, NIH

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