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A heart transplant is a surgical procedure performed to remove the diseased heart from a patient and replace it with a healthy one from an organ donor. In order to remove the heart from the donor, two or more doctors must declare the donor brain-dead. Before a person can be put on a waiting list for a heart transplant, a doctor makes the determination that this is the best treatment option available for the person's heart failure.
The heart is the hardest working muscle in the human body. Located almost in the center of the chest, the adult human heart is about the size of one fist.
At an average rate of 80 times a minute, the heart beats about 115,000 times in one day or 42 million times in a year. During an average lifetime, the human heart will beat more than 3 billion times, pumping an amount of blood that equals about 1 million barrels. Even when a person is at rest, the heart is continuously hard at work.
Reasons for Heart transplant
Heart transplantation is performed to replace a failing heart that cannot be adequately treated by other means.
End-stage heart failure is a disease in which the heart muscle is failing severely in its attempt to pump blood through the body, and in which all other available treatments are no longer helping to improve the heart's function. End-stage heart failure is the final stage of heart failure. Heart failure, also called congestive heart failure, or CHF, is a condition that occurs when the heart is unable to pump blood sufficiently. Despite its name, a diagnosis of heart failure does NOT mean the heart is about to stop beating. The term "failure" refers to the fact that the heart muscle is failing to pump blood in the normal manner because it has become weakened.
Some causes of CHF, or weakening of the heart muscle, may include, but are not limited to, the following:
- Heart attack (also called myocardial infarction)
- Viral infection of the heart muscle
- High blood pressure (hypertension)
- Valvular heart disease
- Congenital (present at birth) heart conditions
- Cardiac arrhythmias (irregular heartbeats)
- Pulmonary hypertension (elevated blood pressure within the lung blood vessels)
- Alcoholism or drug abuse
- Chronic lung diseases, such as emphysema or chronic obstructive pulmonary disease
- Cardiomyopathy (an enlargement of the heart muscle)
- Anemia (low red blood cell count)
There may be other reasons for your doctor to recommend heart transplantation.
As with any surgery, complications may occur. Potential risks associated with heart transplantation may include, but are not limited to, the following:
- Bleeding during or after the surgery
- Blood clots that can cause heart attack, stroke, or lung problems
- Breathing problems
- Kidney failure
- Coronary arteriopathy (similar to coronary artery disease)
Because of the wide range of information necessary to determine eligibility for transplant, the evaluation process is carried out by a transplant team. The team includes a transplant surgeon, a transplant cardiologist (doctor specializing in the treatment of the heart), one or more transplant nurses, a social worker, and a psychiatrist or psychologist. Additional team members may include a dietician, a chaplain, and/or an anesthesiologist.
Components of the transplant evaluation process include, but are not limited to, the following:
- Psychological and social evaluation. Psychological and social issues involved in organ transplantation, such as stress, financial issues, and support by family and/or significant others are assessed. These issues can significantly affect the outcome of a transplant.
- Blood tests. Blood tests are performed to help determine a good donor match and to help improve the chances that the donor organ will not be rejected.
- Diagnostic tests. Diagnostic tests may be performed to assess your lungs as well as your overall health status. These tests may include X-rays, ultrasound procedures, computed tomography (CT scan), pulmonary function tests, and dental examinations. Women may receive a Pap test, gynecology evaluation, and a mammogram.
- Other preparations. Several immunizations will be given to decrease the chances of developing infections that can affect the transplanted heart.
Heart transplantation requires a stay in a hospital. Procedures may vary depending on your condition and your doctor's practices.
Generally, heart transplantation follows this process:
- You will be asked to remove any jewelry or other objects that may interfere with the procedure.
- You will be asked to remove your clothing and will be given a gown to wear.
- An intravenous (IV) line will be started in your hand or arm prior to the procedure for injection of medication and to administer IV fluids, if needed. Additional catheters will be inserted in your neck and wrist to monitor the status of your heart and blood pressure, as well as for obtaining blood samples. Alternate sites for the additional catheters include the subclavian (under the collarbone) area and the groin.
- A catheter will be inserted into your bladder to drain urine.
- If there is excessive hair at the surgical site, it may be clipped off.
- Heart transplant surgery will be performed while you are asleep under general anesthesia. A tube will be inserted through your mouth into your lungs. The tube will be attached to a ventilator that will breathe for you during the procedure.
After the surgery you may be taken to the recovery room before being taken to the intensive care unit (ICU) to be closely monitored for several days. Alternatively, you may be taken directly to the ICU from the operating room. You will be connected to monitors that will constantly display your electrocardiogram (ECG or EKG) tracing, blood pressure, other pressure readings, breathing rate, and your oxygen level. Heart transplant surgery requires an in-hospital stay of seven to 14 days, or longer.