Some patients with severe heart disease may benefit from transplantation. Your cardiologist or pulmonary medicine specialist may refer you to a transplant center for an evaluation. The purpose of the evaluation is two-fold:
· To determine the severity of your disease and whether there are any more conventional treatments
· To determine whether you would be able to survive the transplant operation and have a good long-term result afterwards
A successful transplant will dramatically improve your symptoms of heart disease. Many transplant recipients can perform the same physical activities and enjoy the same quality of life as those without transplants. All transplant recipients, however, are committed to daily drug treatment and close medical supervision for the rest of their lives.
The transplant evaluation is very thorough. In addition to specific heart assessment, tests are performed to determine the function of all the major organ systems, screen for infectious diseases and cancer, and try and predict how well you and your family will cope with the rigors of the transplant regimen. Many of the tests, even the complex ones, are fairly standardized and can be performed in your local community. Some tests may require you to be briefly admitted to a hospital.
Every potential candidate must make at least one outpatient visit to RELA INSTITUTE AND MEDIACL CENTRE to meet with the transplant doctors, coordinators and social worker. Typically, most of the evaluation can be completed within a week or two.
The transplant team meets weekly to discuss patient evaluations and make decisions on appropriate treatment. Patients who are felt to be good candidates for transplantation are then put on a national waiting list.
Unfortunately, the waiting times for heart transplants are long – often more than 3 months. Each patient on our waiting list returns for an outpatient visit to our transplant clinic every month, or more frequently if necessary.
While many patients can wait at home, sometimes it is necessary for patients to be admitted to the hospital in order to remain in satisfactory condition until transplantation.
Unfortunately, the waiting times for heart transplants are long – often more than 3 months. Each patient on our waiting list returns for an outpatient visit to our transplant clinic every month, or more frequently if necessary.
While many patients can wait at home, sometimes it is necessary for patients to be admitted to the hospital in order to remain in satisfactory condition until transplantation.
When the transplant team decides that a potential donor is suitable for one of our recipients, Transplant coordinator will contact the patient as soon as possible. Since it is not possible to predict when a suitable organ will become available and there is a limited amount of time to recover the organs successfully, it is very important that we be able to locate recipients quickly and get them into the hospital in a timely fashion.
This depends on each patient's specific situation. During the evaluation interview, the transplant surgeon will review the details of the surgical procedure, the risks of the procedure and the expected recovery after surgery.
This depends on your specific situation. Although patients can recover sufficiently after heart transplantation to be discharged within 30 days, it is more typical for patients to be hospitalized for Four weeks or more.
We require all patients to be within 30 minutes driving distance of the transplant center for the first six weeks post discharge. The frequency of follow-up visits and lab tests during this interval can be a problem for patients who live far away. The social worker can help you locate suitable guest housing in the area.
Generally, most patients do not report a lot of pain after heart transplant surgery. The incision does cause pain or discomfort when you cough. We will give you pain medication and specific instructions to lessen the pain.
Your family can accompany you until you go into the transplant surgery. While you are in the intensive care unit, family members may not stay in your room. If you need assistance finding guest housing, a social worker will help you.
We have very open visiting hours and encourage family members to spend time with you. However, in order to protect you from infection, anyone who is ill – with a cold or flu, for example – should not visit.
The scar is down the center of the chest. It starts at the noch, or top of the sternal bone, just under your neck, and ends just past the end of the sternal bone. Initially the scar is more prominent. Over time, it will fade to a very light, thin line.
You will be on three main immunosuppressive, or anti-rejection, medications after your heart transplant. Along with the immunosuppressive medications you will need to take several medications that help protect your body from infection.
After heart transplantation, you can drive when your sternum, or breastbone, is fully healed. This takes about six weeks.
You may return to work three to four months after the transplant surgery.
It generally takes three to six months to fully recover from heart transplant surgery. However, age and previous medical problems may cause a longer recovery period.
We have a financial counselor who will verify your insurance coverage. We will obtain authorization for your transplant and follow-up care.
We have support groups for patients on the waiting list as well as for after the transplant. You will be notified of the support group meetings and the topic each month.
Some patients with severe lung disease may benefit from transplantation. Your cardiologist or pulmonary medicine specialist may refer you to a transplant center for an evaluation. The purpose of the evaluation is twofold: first, to determine the severity of your disease and whether there are any more conventional treatments; and second, to determine whether you would be able to survive the transplant operation and have a good long-term result afterwards.
A successful transplant will dramatically improve your symptoms of lung disease. Many transplant recipients can perform the same physical activities and enjoy the same quality of life as normal people. All transplant recipients, however, are committed to daily drug treatment and close medical supervision for the rest of their lives.
The transplant evaluation is very thorough. In addition to specific lung tests, tests are performed to determine the function of all the major organ systems, screen for infectious diseases and cancer, and try and predict how well you and your family will cope with the rigors of the transplant regimen. Many of the tests, even the complex ones, are fairly well standardized and can be performed in your local community. Some tests may require you to be admitted to hospital briefly. We require that every potential candidate make at least one outpatient visit to UCSF Medical Center to meet with the transplant physicians, coordinators and social worker. Typically, most of the evaluation can be completed within a week or two. The transplant team meets weekly to discuss patient evaluations and make decisions on appropriate treatment. Patients who are felt to be good candidates for transplantation are then put on a national waiting list.
Unfortunately the waiting times for organ transplants are long. In 2024 in INDIA, the average wait for lung transplantation was over a 6 months. Each patient on our waiting list returns for an outpatient visit to our transplant clinic every months or more frequently if necessary. While many patients can wait at home, sometimes it is necessary for patients to be admitted to the hospital to maintain them in satisfactory condition until transplantation.
When the transplant team decides that a potential donor is suitable for one of our recipients, we call their home phone number. It is not possible to predict when a suitable organ will become available and there is a limited amount of time to be able to recover the organs successfully. It is very important that we be able to locate the recipient quickly and get him or her into the hospital in a timely fashion.
This depends on your specific situation. The transplant surgeon will review the details of the surgical procedure, the risks of the procedure and the expected post-operative convalescence during the evaluation interview.
This depends on your specific situation. Although patients can recover sufficiently after lung transplantation to be discharged within 30 days, it is more typical for patients to be hospitalized for 6 weeks or more.
Most patients are discharged home after transplant. Although we do not have any specific requirement about staying close to the hospital during the early post-transplant period, the frequency of follow up visits and lab tests during this interval can be a problem for patients who live far away. The social worker can help you to locate guest housing in the area.
Generally, most patients do not report a lot of pain. You will have an incision that does cause pain and discomfort when coughing. We will give you pain medication and specific instructions to lessen the pain.
Your family can accompany you until you go into the transplant surgery. While you are in the intensive care unit, family members may not stay in your room. If you require assistance with locating guest housing, a social worker will be able to help you. We have very open visiting hours and encourage family members to be present. If your visitors are ill (flu or colds), they should not visit you. This is to protect you from the infection.
You may drive after two to three weeks, once your incision is healed. You may return to work after two to three months from the transplant surgery
You will be on three main immunosuppressive (anti-rejection) medications after transplant. Along with the immunosuppressive medications you will need to take several preventive medications against infection.
It generally takes three to six months to fully recover from the transplant surgery. Age and previous medical history problems may cause the recovery period to take longer.
We have a financial counselor who will verify your insurance. We will obtain authorization for your transplant and follow up care.
We have a support group for patients on the waiting list and post-transplant patients. You will be notified of the support group meetings and the topic each month.
Sometimes a person’s heart and lungs need help. In a healthy person, the heart pumps blood to the lungs, where the blood picks up oxygen. Then the bloodstream carries that oxygen to the rest of the body.
When the heart or lungs aren’t working right, doctors may need to support them with medications or a mechanical ventilator. When those treatments aren’t enough, ECMO can help.
No. ECMO will not cure the injured heart or lungs. It can support them for treatment and healing.
The ECMO team places tubes in some of the largest blood vessels in the patient’s body, in the neck, chest or groin.
One tube takes blood from the patient to the ECMO machine. Another tube returns the blood to the patient. The blood is warmed to body temperature before it goes back.
People on ECMO are also often on ventilators.
ECMO uses equipment that may look and sound strange or scary. Our team can tell you what each part does.
We may also give:
· Medication to lower the risk of blood clots.
· Blood products.
· Antibiotics, to treat infection.
· Sedatives, for comfort.
ECMO may affect a patient’s ability to talk because:
· They may have a tube in their mouth or throat that connects to a ventilator to help them breathe.
· The medications that help keep them comfortable may make them sleepy and less likely to interact.
Some people may be awake and off the ventilator. It is more likely that they can talk and interact with visitors and the health care team.
People on ECMO have feeding or IV tubes. They typically can’t eat or drink.
No. We place the tubes while the patient is under anesthesia. Patients also get pain medication and sedatives to help them relax or sleep. If they’re awake, they may not feel any discomfort.
If an ECMO patient is uncomfortable, we want to know right away.
· If the person is awake and interacting, they may be able to communicate their comfort level.
· With people who are sleepy or sedated, our health care team is trained to look for signs of discomfort, including facial expressions, heart rate and blood pressure.
We can increase comfort by moving the person into a new position or offering medications.
That depends on the person’s condition. Some people stay on ECMO a few days. Other people need it longer.
As a person’s heart and lungs recover, ECMO support is gradually reduced. Once the patient recovers, we withdraw ECMO.
People on ECMO are in a hospital’s ICU. At OHSU, someone on ECMO may be in our medical, cardiac or trauma ICU.
Our care teams include specialists in:
· ECMO
· Intensive care · Palliative care, to relieve symptoms and anxiety · Cardiology (heart failure care)
· Cardiac Surgery
· Nephrology (kidney care) · Infectious diseases
We provide daily updates on patients’ conditions. We also answer questions in person or by phone.
Risk of bleeding: Some bleeding is normal. If someone bleeds too much, we may transfuse blood products or perform surgery.
Risk of blood clots or stroke: Sometimes a clot or air bubble gets into the blood of a person on ECMO. We may give blood thinners (like heparin) to prevent clots. Sometimes a person on blood thinners will have bleeding in the brain, which can cause a stroke. We check each ECMO patient’s blood and central nervous system regularly.
Risk of infection: We may give antibiotics to treat infection.
Possible problems with the ECMO machine: All ECMO team members at OHSU have safety and emergency training.
ECMO might not work or might cause serious complications: A person’s heart and lungs might not recover fully. Their condition could get worse. They may have uncontrolled bleeding or develop a life-threatening infection.
Sometimes ECMO keeps someone alive who would die without it. While a person is on ECMO, we will talk with you about chances for recovery and whether ECMO support should continue.
The equipment we use for ECMO limits the space we have for visitors in patient rooms. We don’t recommend staying overnight in a patient room. We can give you a list of nearby places to stay. Our health care team may make some exceptions.
If someone is at risk for infection, we may limit visits or physical contact.
If you can visit, you can:
· Hold their hand or touch them if physical contact is safe.
· Talk to them. Even if they can’t answer, hearing your voice can help.
· Watch movies, TV or videos together.
· Play music or sing.
· Listen to a podcast or audiobook together.
Many people on ECMO are given sedatives to keep them comfortable. They may seem to be sleeping and may not remember interacting with you. Our health care team can help you find meaningful ways to comfort them.
The conditions we use ECMO for vary widely, but include severe pneumonia, severe forms of the acute respiratory distress syndrome (ARDS), severe asthma (status asthmaticus), pulmonary hypertensive crisis, massive pulmonary embolism (blood clot in the lungs), acute coronary syndrome (heart attack), acute decompensated heart failure, severe myocarditis, and post-cardiotomy shock (shock following open heart surgery).
An LVAD, or Left Ventricular Assist Device, also sometimes known as a heart pump, is a heart failure device implanted in the left side of your heart to help pump blood to the rest of the body.
If you or your loved one have advanced heart failure (NYHA Class IIIB or IV) and are not responding to medications or other treatments your doctor may recommend an LVAD to help your heart pump to improve blood flow by helping your heart pump.
For people with advanced heart failure, a left ventricular assist device (LVAD), also known sometimes as a heart pump, is connected to your heart and helps the pumping of blood from the left ventricle which is the primary pumping chamber. The LVAD then helps pump blood to the rest of your body, helping to relieve some of the symptoms of heart failure.
Short-term therapy can be used for patients who are awaiting a heart transplant, or as a bridge to recovery. Long-term therapy is when patients are not a heart transplant candidate due to age, weight, compliance, or it is their choice to have an LVAD over a transplant. LVADs are not a permanent solution but can effectively help patients long-term relieve symptoms of advanced heart failure while awaiting transplant or other therapy or as destination therapy for those who aren’t candidate for another treatment option, giving patients and their care team valuable time.
There are many variables that affect how long a patient can live with an LVAD. It is common for LVAD patients to live several years with the device, depending on their health. If you are considering an LVAD your doctor will be able to explain the factors that will impact how long you can expect to have your LVAD.
Patients with an LVAD may not have a regular heart beat due to how an LVAD helps circulate blood throughout the body. Patients usually will feel a heartbeat, although it might be different from what you felt before the LVAD was implanted.
LVAD surgery is considered a major surgery, and like all surgeries, there are risks, including bleeding, stroke, thrombosis, infection, and device-related complications. Your healthcare team will discuss these risks with you before the procedure.
LVAD patients may return to a relatively normal life and usually the relief of symptoms often assists in allowing patients to enjoy activities that may have been previously discontinued due to advanced heart failure symptoms. However, some physical activities (may be limited due to the LVAD e.g. swimming), and you'll need to follow your doctor's advice for specific exercise and lifestyle recommendations.
For the most part, your LVAD will not drastically restrict your food options although sodium and fluid intake may need to be monitored. Based on your specific situation, if you have any other health conditions (e.g. diabetes) your diet may be restricted. Your doctor will discuss these with you prior to your procedure.
Traveling with an LVAD is possible, but it requires advanced planning. You'll need to ensure you have enough power sources, backup equipment and a plan in place in case of emergencies. Be sure to discuss your travel plans with your healthcare team well in advance of your trip.
Every patient’s journey will be different, but there are some typical steps in preparing for LVAD surgery for treatment of advanced heart failure. In preparation for your procedure there will likely be: medical evaluations, lifestyle adjustments, recovery planning and discussing the procedure risks and benefits with your healthcare team.
Many organizations offer support groups for LVAD patients and their families. These groups can provide valuable information and emotional support across the journey. Additionally, Abbott offers a patient ambassador program which connects patients considering an LVAD with those who have had the procedure.
You are able to shower with your LVAD once your incisions have healed. Your MCS team will discuss with you the use of a special shower bag provided by your LVAD company. As you can imagine, it is essential that you not get your equipment wet. Unfortunately, there is no way to swim with this equipment, as it cannot be submerged. At some point in the near future, the hope is to have a fully implantable LVAD system which will allow you to swim and shower with ease.
You will need to be on blood thinners and most likely an aspirin for as long as you have your LVAD. Initially, blood work will be done somewhat frequently to assure that your blood is as thin as it needs to be to allow for the LVAD to work at its best. As with any artificial, mechanical device, blood thinners help to prevent the risk of developing small clots in the device. Watching your diet and understanding the types of food that you eat and how they impact your blood thinners is important. You will discuss this with your MCS team. Your team will strictly monitor your blood thinners and aspirin doses based on your blood work and instruct you on how to make changes to the doses when needed.
The line coming out of either your abdomen or chest area is called a driveline. It is what connects the LVAD pump to the controller on the outside of your body that runs the pump. Where the driveline comes out of your body is called the exit site. It is very important that this site be taken care of due to the risk of infection. Once an infection settles inside of this area, it is very hard to get rid of. Also very important to remember when dealing with your LVAD driveline is to keep it as still as you can; excessive movement at the exit site almost always causes local irritation, which can turn into an infection. Your MCS team will teach you and your caregiver how to perform the dressing changes required to maintain your driveline and keep it clean and covered.
IABP therapy is used to treat cardiogenic shock. That’s when your heart can’t pump enough blood to meet the needs of your body.
Some heart problems can cause cardiogenic shock. These include:
· Unstable angina
· Heart attack
· Certain abnormal heart rhythms
· Heart failure
· Heart defects
You may also need an IABP if you have a certain medical procedure. For example, you may need it if you have a percutaneous coronary intervention. This procedure opens a blocked artery in the heart. You also might benefit from an IABP if you have heart surgery.
In some cases, you might not be able to use an IABP, even if your heart cannot pump enough blood. For instance, people with a leaky aortic valve can’t safely use an IABP. Those with aortic aneurysms also can’t benefit from this therapy choice.
IABP therapy can be very helpful. It can sometimes even be life-saving. But it does have some risks. These include:
· Damage from the lack of blood flow (ischemia)
· Injury to an artery
· Rupture of the balloon
· Incorrect position of the balloon (might cause injury to the kidneys or other problems)
· Low platelet count(might cause excess bleeding because your blood doesn’t clot as well)
· Infection
· Stroke
Your own risks depend on your age and any other health conditions you may have. For instance, a lack of blood flow to your leg may be more likely if you have peripheral vascular disease.
Before your procedure, talk with your healthcare provider about all your concerns. You will be asked to sign a form consenting to the procedure. Be certain to ask any questions you have before you sign. They will give you detailed instructions. Be sure to tell your healthcare provider if you are pregnant or think you could be. Also let them know if you have:
· Any other health conditions
· A problem with sedation
· New symptoms, such as a sudden fever
If you smoke, you should try to stop before your procedure. It will help reduce your chance of complications. You should also not eat or drink anything after midnight before the day of your procedure. You may also need to stop taking any medicines. Before and during the treatment, you will likely need to take medicine to help prevent blood clots.
You may need other tests to evaluate your health beforehand. These might include:
· Blood work to check for anemia and infection
· Electrocardiogram to check your heart rhythm
· Chest X-ray to view your heart and lungs
· Echocardiogram to view how well your heart is pumping
· Cardiac catheterization to see how widespread your coronary disease is
For this procedure, the balloon-tipped catheter is inserted into a blood vessel and advanced to the heart. This often happens during a heart-related surgery. In an emergency, a medical team may insert it at your bedside or in the cardiac catheterization lab.
Your healthcare provider can tell you exactly what to expect. In general, the procedure has the following steps:
· You’ll first receive some anesthesia. If you are having the insertion during surgery, you may already be under general anesthesia. In that case, you will be asleep and won’t feel anything. In other cases, you may get medicine to help you relax. You will also get numbing medicine at the insertion site.
· During the procedure, your heart rate, blood pressure, and other vital signs will be watched.
· A small cut will be made through an artery in the upper part of your inner thigh/groin. The balloon catheter will be inserted there.
· A surgeon will advance the catheter to a part of the aorta in your chest region. They can see this movement using continuous X-ray imaging (fluoroscopy).
· The balloon will be programmed to inflate when your heart relaxes. It will deflate when your heart contracts
· The end of the catheter will be secured, so it stays in place.
You may feel some chest pain after the procedure. It should go away within minutes of starting the IABP. If you are still having symptoms, you may need further treatment.
Your healthcare provider will watch for complications. You will need to stay in bed afterward and until the IABP is removed. The head of your bed should be slightly raised (elevated). The leg with the catheter insertion should remain straight. That will help keep the balloon from moving out of place. You may also need daily chest X-rays to make sure the device is still in the correct spot. The pump normally makes sounds as it cycles between inflation and deflation.
Tell your provider right away about any new symptoms, such as bleeding from the insertion site. Chest pain might be a sign that the timing of your device needs to be adjusted. A pale color or tingling in your leg may point to reduced blood flow to that region.
You may need to stay on the pump for several days. Your healthcare provider will watch you. They may temporarily turn the pump off to see how you respond. Or they may set it to inflate and deflate with only every second or fourth heartbeat. If your heart continues to pump well on its own, you may be ready to stop the IABP therapy. You might also stop the therapy when another intervention becomes available. This might be a donated heart or permanent mechanical assist device.
When it's time to remove the pump, you will likely get medicine to help you relax. Your provider will then remove the catheter and the attached balloon. They will also close up the incision on your leg or apply direct pressure for a few minutes.
Your provider may give you other instructions about what to expect. Follow these carefully to help increase your chances of a positive outcome.
