Heart Transplantation surgeryHeart transplantation, or cardiac transplantation, is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease. The most common procedure is to take a working heart from a recently deceased organ donor (allograft) and implant it into the patient. Thus a heart transplant is surgery to remove a person's diseased heart and replace it with a healthy heart from a deceased donor. Ninety percent of heart transplants are done on patients who have end-stage heart failure.Heart failure is a condition in which the heart is damaged or weakened and can't pump enough blood to meet the body's needs. "End-stage" means the condition has become so severe that all treatments, other than heart transplant, have failed. The patient's own heart may either be removed (orthotopic procedure) or, less commonly, left in to support the donor heart (heterotopic procedure); both are controversial solutions to one of the most enduring human ailments. Post-operation survival periods now average 15 years. Ninety percent of heart transplants are done on patients who have end-stage heart failure.
Some facts about Heart Transplant
A heart transplant is an open-heart surgery in which a severely diseased or damaged heart is replaced with a healthy heart from a recently deceased person.Worldwide there are 3,500 heart transplants performed every year; about 800,000 people have a severe heart defect and need a new organ.
Finding a donor heart can be difficult. The donor is usually an unfortunate person who has suffered irreversible brain injury, called "brain death". But his/her organs, other than the brain, are working well with the help of medications and other "life support" that may include a respirator or other devices. A team of physicians, nurses, and technicians goes to the hospital of the donor to remove donated organs once brain death of the donor has been determined. The removed organs are transported on ice to keep them alive until they can be implanted. For the heart, this is optimally less than six hours. So, the organs are often flown by airplane or helicopter to the recipient's hospital. The donor heart must be matched as closely as possible to your tissue type to reduce the chance that your body will reject the new heart
Unfortunately, the number of people waiting for a heart transplant is higher than the number of available organs. About 2,657 patients were waiting for a heart transplant in the United States as of July 2008, according to the United Network for Organ Sharing (UNOS), and 2,210 people received donated hearts in 2007.The heart is donated by someone who has been declared brain-dead but remains on life support.
What types of patients are recommended for Heart Transplant?
In order for a patient to be recommended for a heart transplant they will generally have advanced, irreversible heart failure with a severely limited life expectancy. Other possible treatments for their condition, including medication, should have been considered prior to recommendation.
- Severe angina that can no longer be treated with medications or surgeries to repair the coronary arteries
- Severe heart failure, when medicines, other treatments, and surgery no longer help.
Possible causes of severe heart failure are:
- Coronary artery disease
- Cardiomyopathy (Disease of the heart muscle. Some medicines, alcohol, and pregnancy can damage the heart valves and muscles.)
- Heart valve disease with congestive heart failure
- Severe heart defects that were present at birth and cannot be fixed with surgery
- Life-threatening abnormal heart beats or rhythms that do not respond to other therapy
What type of patients are less suitable for Heart Transplant?
Some patients are less suitable for a heart transplant, especially if they suffer from other circulatory conditions unrelated to the heart. The following conditions in a patient would increase the chances of complications occurring during the operation:
- Kidney, lung, nerve, or liver diseases that can't be reversed.
- History of cancer or malignant tumors.
- Insulin-dependent diabetes with other organ dysfunction
- Life-threatening diseases unrelated to heart failure
- Other diseases that affect the blood vessels of the neck and leg .
- Infections such as hepatitis, that are considered to be active .
- High pulmonary vascular resistance(high blood pressure in the lungs).
- Recent thromboembolism
- Age over 60 years (some variation between centres)
- Smoking, alcohol or drug abuse, or other lifestyle habits that may damage the new heart .
How does the procedure of Heart Transplant works?
Patients who are eligible for a heart transplant are placed on a waiting list for a donor heart. This waiting list is part of a national allocation system for donor organs run by the Organ Procurement and Transplantation Network (OPTN). OPTN follows a policy to make sure donor hearts are given out fairly. These policies are based on some issues like urgency of need. A suitable donor heart being located from a recently deceased or brain dead donor and donor is younger than 65 years old, have little or no history of heart disease or trauma to the chest, and is not exposed to hepatitis or HIV. It is recommend that the donor heart not be without blood circulation for more than 4 hours.Organs are matched for blood type and size of donor and recipient
As soon a sutaible donar heart is available the transplant patient is contacted and instructed to attend the hospital as quick as possible in order to be evaluated for the operation and given pre-surgical medication. At the same time, the heart is removed from the donor and inspected by a team of surgeons to see if it is in a suitable condition to be transplanted. Not all patients who are called to the hospital will get a heart transplant. Sometimes, at the last minute, doctors find that a donor heart isn't suitable for a patient.This can often be a very depressing experience for an already emotionally unstable patient. The patient must also undergo several emotional, psychological, and physical tests to make sure that they are in good mental health and will make good use of their new heart. The patient is also given immunosuppressant medication so that their immune system will not reject the new heart.
Once the donor heart has cleared all its inspection, the patient is taken into the operating room and given a general anesthetic. General anesthesia temporarily puts the patient to sleep. Then either an orthotopic or a heterotopic procedure is followed, depending on the patient's condition and the condition of the donor heart.
- Orthotopic procedure : A bypass machine is hooked up to the arteries and veins of the heart. The machine pumps blood through
the patient's lungs and body while the diseased heart is removed and the donor heart is sewn into place.Heart transplant surgery
usually takes about 4 hours. Patients often spend the first days after surgery in the intensive care unit of the hospital.
- Heterotopic procedure : In the heterotopic procedure, the patient's own heart is not removed before implanting the donor heart. This is effectively a 'double heart' as the new heart is positioned and the chambers and blood vessels of both hearts are connected . In this procedure the patients original heart is given a chance to recover, and if the donor's heart happens to fail because of rejection from the patient body, it may be removed, allowing the patients original heart to start working again. Heterotopic procedures are only used in cases where the donor heart is week and cannot function by itself (due to either the patients body being considerably larger than the donor's, the donor having a weak heart, or the patient suffering from pulmonary hypertension).
The patient is taken into ICU to recover. When the patient wakes up, he/she will be transferred to a special recovery unit for rehabilitation. The amount of time a patient spends in the hospital after transplantation will vary with each person and depends on his/her general health, how well the new heart is working, and his/her ability to look after the new heart. Doctors typically like the new recipients to leave hospitals soon after surgery because there is risk of infection in a hospital this is probably 1 - 2 weeks without any complications. Once the patient is released, 3 months of monitoring is required. That is he/she have to return to the hospital for regular check-ups and rehabilitation sessions. The number of visits to the hospital will decrease over time, as the patient adjusts to their transplant. The patient will have to remain on lifetime immunosuppressant medication to avoid the possibility of rejection. Since the vagus nerve is severed during the operation, the new heart will beat at around 100 bpm until nerve regrowth occurs.
What are the sign of rejection of the new heart in the patient body?
The new heart is a “foreign body” the patient's immune system may attack if he/she is not getting enough medicine to suppress the immune system after the surgery.The sign of rejection includes..
- Shortness of breath
- Fatigue or tiredness
- Weight gain that is retaining fluid in the body
- Reduced amounts of urine which may be due to problems in the kidneys .
What are the risk from Heart Transplant?
Although heart transplant surgery is a life-saving measure, it has many risks. Risks of heart transplant include...
- Failure of the donor heart
- Increased risk for infections due to anti-rejection (immunosuppression) medications
- Risks for any surgery
- Wound infections
- Blood clots that is deep venous thrombosis
- Damage to the kidneys, liver, or other body organs from anti-rejection (immunosuppression) medications
- Heart attack or stroke
- Heart rhythm problems
What are Other Complications with Heart Transplant?
Other Complications may include...
- In more than 70 percent of heart transplant patients develops high blood pressure in the first year after transplant and in mostly 95 percent of patients within 5 years.
- More than 50 percent of heart transplant patients suffer from high levels of cholesterol and triglycerides in the blood develop in the first year after transplant and within 5 years mostly 84 percent of patients .
- Osteoporosis can develop or worsen in heart transplant patients. This condition thins and weakens the bones.