Heart transplant

Specialty of Paediatric cardiothoracic surgery

What is a heart transplant? 

A heart transplant is an operation that is carried out to replace a damaged or failing heart with a healthy heart from a donor. It is only performed on people who have tried other treatments and types of surgery but have not noticed any improvement.

A heart transplant is a complex procedure. Once done, if adequately monitored, the chances of survival increase.    

Why would it be done?

A heart transplant is done when a variety of other treatments have been unable to ease heart problems, and heart failure occurs. The transplant is performed for the following reasons:

  • There is serious damage after a heart attack
  • There is severe heart failure after medications and other surgeries have not been able to solve the issue
  • The patient has congenital heart abnormalities that other types of surgery can’t help
  • The patient has heart palpitations that could be fatal which haven’t responded to other types of treatment.

Heart failure may be caused by:

  • A weak heart, heart disease
  • Coronary artery disease
  • Congenital heart defect
  • Ventricular arrhythmias
  • Amyloidosis
  • If a transplanted heart causes problems and fails.

What does it involve?  

A heart transplant is open heart surgery; a damaged heart is replaced with the healthy heart of a deceased person who has chosen to donate their organs. The donated heart must be healthy and as compatible as possible for the patient receiving the transplant, to avoid rejection.

The procedure involves general anaesthetic. Once the patient has been sedated, incision is made through the sternum and the surgery is started. The patient’s blood will go through a heart-lung bypass machine to ensure high levels of oxygen in the blood.   

Once the incision has been made, the unhealthy heart is removed and replaced with the healthy heart. Once the donor heart has been stitched into place, the extracorporeal machine is disconnected, allowing the blood to flow through the heart.     

Tubes are attached to let air, liquid, and blood pass through so the lungs are able to expand normally.

How to prepare for it.

When a patient is told that they must have a heart transplant, they need to have a series of tests done to see if they are suitable for the procedure. A specialist team will look at a variety of test results including blood tests and X-rays. The following tests may be carried out:  

  • Kidney and liver test
  • Electrocardiographs, echocardiograms, and cardiac catheterisations to check the state of the heart
  • Tests for cancer
  • Ultrasound.

Once the patient has been tested and deemed an appropriate candidate, they will be put on a waiting list.   

The placing on the waiting will depend on the type and seriousness of the heart disease.

Post-operative care.

A heart transplant patient may need to stay in hospital between one and three weeks after the operation. They will more than likely be in the Intensive Care Unit (ICU) for the first 48 hours after the operation. For the first few days following surgery, the patient needs to be carefully monitored to avoid an infection.  

The recovery period after a heart transplant is estimated at three months. Blood test and check-ups will be almost constant at this stage.    

The patient should take immunosuppressant medications to ensure that the body doesn’t reject the new organ. It is common to carry out biopsies during the first year to check the organ.  

The patient can return to everyday life after around three months.

A transplant extends the life of the patient, who likely die without it. The main risk is rejection, however, if monitored correctly, life expectancy is increased by more than 10 years.      

Alternative options

A transplant is thought of as the ideal treatment for patients in whom other methods have failed.  The issues is that the waiting list is longer than the donor list.    

There are a number of factors that prevent a person receiving a transplant, they include: the person is malnourished, is over 65 years old, has had a recent stroke, has recently had cancer, has HIV or hepatitis, is a drug or alcohol user, or has pulmonary hypertension or diabetes.

Some alternative methods include:     

  • Cardiac resynchronisation: the heart is stimulated to restore normal working order.
  • Ventricular assistance: a left ventricular assist device is implanted.
  • Surgical treatment: procedures include; coronary revascularisation in ischemic cardiomyopathy, mitral regurgitation surgery, or a partial left ventriculectomy.    
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