A heart transplant is the substitution of a sick heart with a healthy one. The new heart is evaluated to ensure it is free of disease and is compatible with the receiving patient. This procedure is recommended for patients with severe heart conditions who have exhausted other medical interventions without therapeutic effect.
A heart transplant is a delicate and highly complex surgery. It is performed by a team that is specialized in heart transplants. It is for transplant patients to follow their doctor's instructions post-operatively to avoid complications.
Check-out the video below to learn more about heart transplants:
When it is recommended
Heart transplanted may be recommended for:
- Severe coronary artery disease
- Congential heart disease
- Severe cardiac valve disease
- Uncontrolled ventricular arrhythmia that is not response to other treatments
A heart transplantation is usually recommended when the patient's heart disease is at a very advanced stage and does not respond to other normal treatments, as these patients are at a high risk for developing heart failure.
A transplant can be performed on patients of all ages, however the approval of this procedure will will also depend on the status of the patient's other organs, such as the brain, liver and kidneys. The patient may not benefit from the transplant if many of the organs are compromised.
How the surgery is performed
A heart transplant is carried out by a multidisciplinary team made-up of doctors, nurses, physiotherapists, and registered dietitians, who are specifically trained for this purpose. A heart transplant is a complex and delicate procedure in which the sick heart is removed and replaced with a healthier, compatible one.
The procedure is carried out in a hospital-setting with all appropriate equipment. The patient is put under general anesthesia, and remain hospitalized following surgery. There is additional care required after discharge to reduce the risk of organ rejection.
The surgery is performed with the following steps:
- Anesthetize the patient in the operating room.
- Make an incision on the patient's chest, and connect the patient to a heart-lung machine (cardiopulmonary bypass pump) which will help to pump blood throughout the body during the surgery.
- Remove the sick heart, and suture in the donor heart.
- Close the thorax by sewing-up the incision.
Heart transplant surgery takes several hours and the post-operative period will be led by a multidisciplinary team. The patient will remain hospitalized in the Intensive Care Unit (ICU), until they are transferred to the appropriate department for monitoring, and then home.
Heart transplantation has absolute contraindications, in which the patient is not a candidate to undergo the transplant. There are also relative contraindications, in which the transplant can be considered after evaluating the person's condition.
1. Absolute contraindications
There are some contraindications that are considered to be absolute for heart transplantation. They mean that the person is automatically not a candidate for heart transplant surgery, and can include:
- Blood incompatibility between the receiver and the donor
- Liver failure or irreversible kidney failure
- Active local or systemic infection
- Diabetes with damage to other organs, like nephropathy, neuropathy or retinopathy
- Serious pulmonary disease
- Pulmonary embolism less than 3 months ago
- Pulmonary hypertension or irreversible pulmonary vascular resistance
- Serious psychiatric disease
- Current drug abuse
- Active smoker
- A life expectency of less than 2 years
- Diseases like amyloidosis, sarcoidosis, hemochromatosis or lupus
- Active cancer
- History of cancer in the last 5 years, except for localized non-melanoma skin cancer, or stage 1 breast or prostate cancer
Furthermore, heart transplantation is contraindicated in cases of chronic viral infections, such as HIV, hepatitis B or hepatitis C. However, in these cases, a transplant can be performed if the viral count is undetectable and there is no evidence of damage to other organs.
Another absolute contraindication is in the case of patients who are not committed or are unable to make lifestyle changes following the transplant, such as not smoking, stopping any drug abuse, avoiding alcohol and not following the prescribed post-op treatment.
2. Relative contraindications
Current advances in medicine have allowed for previous absolute contraindications to be evaluated on a case-by-case basis. One example includes patients over 70 years of age with a high chance of benefiting from the transplant. Patients with kidney or liver abnormalities may benefit from multiple organ transplants such as heart and kidney or heart and liver transplants.
These conditions must be evaluated individually by the doctor, who will assess the benefits and risks associated with this procedure.
Heart transplant surgery is associated with several risks, which is why it is necessary for the patient to remain hospitalized following the surgery and be regularly monitored after discharge. Just like any other invasive procedure, there is an increased risk for infection following the surgery.
There is also a possibility of rejection of the transplanted organ, especially during the first 5 years. Other possible risks include an increased chance of developing atherosclerosis, which is characterized by clogging of the heart arteries, as well as an increased risk of developing cancer, due to the use of immunosuppressants.
Some important healthcare measures that transplant recipients must take following a heart transplant include:
- Taking immunosuppressants
- Avoiding contact with other sick people, as well as polluted environments or cold climates (as viruses can trigger an infection that can lead to organ rejection)
- Maintaining a balanced diet and eliminating all raw foods from the diet. Patients are encouraged to opt for only fully-cooked foods to reduce the risk for infection.
These precautions must be followed throughout the lifetime and are key to allowing the transplant recipient to having a practically normal life. Many are even being able to perform physical activity.