This is an abbreviated version of the complete article.*
Cardiac transplantation, commonly called heart transplant, is the surgical replacement of a person's own irreversibly damaged heart with a healthy donated heart from another person.
A heart transplant is a treatment option for people with end-stage heart disease that does not respond to any other form of therapy, and physicians follow strict medical guidelines to qualify and select potential heart recipients.
Donor hearts are in short supply, and physicians perform only about 2,000 heart transplants worldwide each year.
Cardiac transplantation, commonly called a heart transplant, is the replacement of a person's failing heart with a healthy heart from an organ donor. Cardiac transplant may be the only treatment option for patients who have heart failure caused by:
Prolonged high blood pressure;
Heart attack; or
Coronary artery disease.
In rare cases, heart transplants are performed on patients who have valvular heart disease or congenital heart disease.
Many thousands of Americans with heart failure are potential candidates for a heart transplant each year, but because of a severe shortage of suitable donors, only about 2,000 actually receive a transplant. Survival rates after transplantation are fairly high.
Heart transplant recipients must take immunosuppressant medication for the rest of their lives and undergo frequent examinations.
WHEN IS IT INDICATED?
A heart transplant is considered for patients whose hearts have sustained irreversible damage and whose life expectancy is less than 2 or 3 years. The procedure is only indicated when other treatments for heart failure have not been successful.
WHO IS ELIGIBLE?
Patients who have the best chance of a successful transplant include:
Patients with end-stage heart failure who will likely die within the next 2 to 3 years if they do not undergo a heart transplant;
Patients in otherwise good health;
Patients younger than 60 years old;
Patients who do not smoke, have drug or alcohol problems, or have serious eating disorders; and
Patients who are willing to adhere to a complex drug regimen and undergo frequent examinations.
Once the patient qualifies as a candidate, his or her name will be added to a nationwide list for organ donations.
To help cope with the anxiety and uncertainty surrounding cardiac transplantation, patients can join one of the many support groups available to transplant recipients and their families.
Since the transplant process moves at an extremely rapid pace once a donor heart is found, the patient will carry a pager so that the hospital can easily contact him or her.
At the transplant center, the recipient will undergo a series of tests to ensure that he or she is in satisfactory condition to receive the donor organ, including:
Urine tests; and
Chest x ray.
WHAT TO EXPECT
To begin the operation, the surgeon performs a sternotomy and accesses the heart. The patient is connected to a heart-lung machine, which stops blood from circulating through the heart chambers when the surgeon is working on the heart itself.
Surgeons will then remove the patient's failing heart by making incisions in the atria, aorta, and pulmonary arteries. The surgeon then connects the donor heart's blood vessels to the patient's. At this point, the heart either starts beating on its own or receives a shock to restart it. Once the new heart is beating without support from the heart-lung machine, the patient is weaned from the machine and the chest will be closed. The procedure takes between 3 and 5 hours to complete.
POST TREATMENT GUIDELINES AND CARE
Transplant patients spend 10 days to 3 weeks in the hospital.
After a heart transplant, the patient will need to take the following types of medication for the rest of his or her life:
Medications to help counteract the side effects of the immunosuppressants, such as antacids, diuretics, and antihypertensives.
After the patient leaves the hospital, he or she will need to undergo regular tests monitoring body temperature, weight, pulse, blood pressure, and lung capacity. Other necessary tests include cardiac catheterization, coronary angiography, and intravascular ultrasound.
Infection and rejection are the two most serious transplant complications. Most transplant patients can expect to have at least one rejection episode. The physician can usually halt the rejection by changing the immunosuppressants or the dosage, or by using steroids.
To minimize the chance of complications, patients must strictly follow the physician's instructions regarding medications.
Immunosuppressants have potential serious side effects, including:
High blood pressure;
Kidney function problems;
Weight gain; and
Patients must learn to control their weight and cholesterol through lifestyle changes to prevent high blood pressure, heart disease, and diabetes. Patients are also required to start a physical rehabilitation program under physician supervision.
Medical Review Date: October 1, 2007
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