HEART TRANSPLANT

A heart transplant is a type of heart surgery, during which the recipient’s heart is replaced with a donor’s heart. The heart transplant surgery is performed on a person with a defective or diseased heart that is unable to pump blood efficiently.

Under what conditions is a heart transplant done?

A heart transplant surgery is recommended to manage end-stage heart failure that is resistant to other available treatments.

Heart transplant indications include:

Ischemic heart disease that caused myocardial infarction with coronary artery disease and heart attack

Dilated cardiomyopathy that caused the thinning of the heart muscles

Restrictive cardiomyopathy that resulted in thickening of the heart muscles

Hypertrophic cardiomyopathy leading to enlargement of the heart muscles

Valve heart disease that is resistant to surgeries

Congenital heart disease that causes abnormality of the heart from birth

End-stage heart failure that is resistant to most medications

Pulmonary hypertension or high blood pressure in the lungs

End-stage heart failure patients who are potential candidates for a heart transplant go through a transplant evaluation to determine if they qualify for the transplant. The heart transplant evaluation consists of tests that help the doctors identify if the patient needs a heart transplant. In addition, the tests also help the doctors detect various other heart problems that can arise in the recipient after heart transplant surgery.

Evaluation for transplant:

Heart transplant recipient undergoes screening tests to determine the severity of illness before beginning the heart transplant procedure.

The screening tests consist of:

Medical history and physical exam

Tests to determine the extent of heart damage

Psychological evaluation

Tests to determine the function of other body organs

If the results of these tests show that the patient is a suitable candidate for a heart transplant, he/she is placed on a transplant waiting list for heart transplant surgery.

Heart transplant procedure:

The heart transplant procedure consists of the following steps:

Anesthesia is administered to the patient

The surgeon makes an incision in the breastbone

The surgeon removes the patient’s heart while leaving the atrium

The surgeon places the donor’s heart into the patient’s chest

The donor’s heart is connected to the atrium, aorta, and pulmonary artery

The new heart is circulated with blood; if the heart does not beat on its own, a pacemaker is used to start the beating activity

The patient is then transferred to the intensive care unit (ICU) for a few days because of transplant surgical complications.

Aftercare and recovery:

Aftercare and recovery from a heart transplant involve a series of procedures that help the heart transplant recipients understand that the donated heart is not rejected by the recipient’s body; for example, a heart transplant recipient needs to take immunosuppressant drugs for at least one year to ensure the body does not reject the donor’s heart. Another crucial procedure for heart transplant aftercare includes cardiac rehabilitation, which is a program that every heart transplant recipient is required to undertake to help him/her return to his/her normal life after transplant surgery. This is because cardiac rehab helps the donor heart regain its functionality after transplant surgery. Apart from these procedures, other measures that can be taken to ensure faster recovery after a heart transplant procedure include biopsy, which helps determine the functionality of the transplanted heart and encourages heart transplant recipients to adopt heart-healthy habits because the donor heart should not be subjected to stress. In addition, the heart transplant recipients should consider undergoing psychological counseling because the heart transplant surgery can be emotional for them. Some of the possible heart transplant complications that these patients should look out for after the surgery include donor heart rejection, infections, coronary artery disease, kidney malfunction, and transplant failure.

Survival and prognosis:

Heart transplant patients have good prognosis as long as they are fit during the first year after surgery. For example, 85 to 90 % of heart transplant recipients survive more than one year after surgery, whereas 70 to 75% of heart transplant patients survive for more than five years after surgery. On the other hand, 50 to 60% of heart transplant patients survive for more than ten years after surgery. The survival rates of heart transplant patients vary depending on the patient’s age, general health, and aftercare. Heart transplant patients who survive the first year after transplant usually have a positive prognosis for survival because of the heart transplant procedure and treatment for transplant rejection.

Heart transplant prognosis has improved over time; therefore, heart transplant recipients can lead relatively normal lives with donor hearts.