What is Heart Transplant

Heart transplant is surgery to replace your failing heart with a donor heart. Common reasons for heart failure include coronary artery disease, heart defects you are born with (congenital defects), heart valve problems, or heart infections (myocarditis).

You may need this surgery if no other treatments have worked.

Heart transplant is a major surgery. You will work with a team of health care providers (transplant team) to help you prepare for the procedure and to help you recover. A suitable donor heart needs to be found that is a good match; until then, you will be on a heart transplant waiting list.

Tell a health care provider about:

• Any allergies you have.
• All medicines you are taking, including vitamins, herbs, eye drops, creams, and over-the-counter medicines.
• Any problems you or family members have had with anesthetic medicines.
• Any blood disorders you have.
• Any surgeries you have had.
• Any medical conditions you have.
• Whether you are pregnant or may be pregnant.
• Whether you smoke or use tobacco products. These can affect how the anesthesia works and may slow the healing process.

What are the risks?

This is open-heart surgery. Problems may occur, including short-term and long-term complications.

• Possible short-term problems include:
  • Infection.
  • Bleeding.
  • Allergic reactions to medicines or dyes.
  • Damage to other structures or organs.
  • Organ rejection.
  • The donor heart fails and cannot function (primary graft dysfunction).
• Possible long-term problems include:
  • Narrowing of the blood vessels and arteries (atherosclerosis). This may cause the heart to fail (cardiac allograft vasculopathy).
  • Side effects from medicines taken to suppress your immune system. These side effects may include:
    • Infection.
    • Kidney damage.
    • Bone problems.
    • Cancer.

What happens before the procedure?

• You will have many tests to get ready for transplant surgery. These may include:
  • Physical exams to check heart and lung function.
  • Blood tests.
  • Imaging tests, such as X-rays, ultrasounds, and MRIs.
  • Tests to check your heart function. These may include cardiac catheterization to evaluate your heart arteries and measure the pressures inside your heart.
  • Taking samples of blood and tissue to find a donor match.
• You will be put on a transplant waiting list. When you are placed on the waiting list, the transplant team will tell you how to prepare for the time when a heart becomes available.
• Once you are notified that a donor heart is available, you will have the transplant surgery right away.

Staying hydrated

Follow instructions from your health care provider about hydration, which may include:

• Up to 2 hours before the procedure – you may continue to drink clear liquids, such as water, clear fruit juice, black coffee, and plain tea.

Eating and drinking restrictions

Follow instructions from your health care provider about eating and drinking, which may include:

• 8 hours before the procedure – stop eating heavy meals or foods such as meat, fried foods, or fatty foods.
• 6 hours before the procedure – stop eating light meals or foods, such as toast or cereal.
• 6 hours before the procedure – stop drinking milk or drinks that contain milk.
• 2 hours before the procedure – stop drinking clear liquids.

Medicines

Ask your health care provider about:

• Changing or stopping your regular medicines. This is especially important if you are taking diabetes medicines or blood thinners.
• Taking medicines such as aspirin and ibuprofen. These medicines can thin your blood. Do not take these medicines unless your health care provider tells you to take them.
• Taking over-the-counter medicines, vitamins, herbs, and supplements.

General instructions

• You may be given antibiotic medicine to help prevent an infection.
• You may be asked to shower with a germ-killing soap.

What happens during the procedure?

• To lower your risk of infection:
  • Your health care team will wash or sanitize their hands.
  • Hair may be removed from the surgical area.
  • Your skin will be washed with soap.
• An IV will be inserted into one of your veins.
• You will be given one or both of the following:
  • A medicine to help you relax (sedative).
  • A medicine to make you fall asleep (general anesthetic).
• A long, thin tube (catheter) will be inserted into a large blood vessel in your neck or groin. You will get fluids through this tube.
• You will be given medicines to prevent infection and to prevent rejection of the donor heart.
• A catheter will be inserted into your bladder to drain urine during and after surgery.
• A tube may be placed through your nose and into your stomach (nasogastric tube) to drain stomach fluids.
• The surgeon will make an incision down the center of your chest.
• The breastbone will be cut to expose the heart.
• Blood vessels around your heart will be cut. Tubes will be inserted to take the returning blood to a heart-lung bypass machine. This machine will take over for your heart and lungs during surgery. It will help pump blood and oxygen through your body.
• Your damaged or diseased heart will be removed.
• The new heart will be placed and attached to the blood vessels that were cut.
• The heart-lung bypass machine will be removed once your new heart is working well.
• Your breastbone will be repaired.
• Drainage tubes may be placed in your chest.
• The chest incision will be closed with stitches (sutures) or staples.
• A bandage (dressing) will be placed over the incision.

The procedure may vary among health care providers and hospitals.

What happens after the procedure?

• You will be taken to the hospital’s intensive care unit (ICU) right after the procedure. You may need to stay in the ICU for several days. You may continue to have assisted breathing through a tube in the throat.
• While the breathing tube is in place, medicines will be given to keep you asleep. You will be given pain medicine. You will also be given medicine to prevent rejection of the new heart.
• Your blood pressure, heart rate, breathing rate, and blood oxygen level will be monitored.
• You may be moved to another room at the hospital. You may need to stay in the hospital for several weeks.
• During the hospital stay:
  • You will keep getting nutrients through an IV until you can resume a normal diet.
  • All tubes, drains, and catheters will be removed when it is safe to do so.
  • Staples or sutures may be removed.
  • Dressings will be changed as needed.
  • You may start a cardiac rehabilitation program. This may include education, exercises, and therapy to help you recover.
• Your team of health care providers will give you the medicines you need at home and instructions for home care.
  • After this surgery, you will need to take medicines that prevent your body from rejecting the donor heart (immunosuppressants).

Summary

• A heart transplant is surgery to replace your failing heart with a donor heart.
• A heart transplant may be needed when the heart fails due to coronary artery disease, valve problems, heart defects you were born with (congenital defects), or heart infections (myocarditis).
• Once you are notified that a donor heart is available, you will have the transplant surgery right away.
• You will need to stay in the hospital for several weeks after this surgery.

Care After Heart Transplant

Here is the information about how to care for yourself after your procedure. Your health care provider may also give you more specific instructions. If you have problems or questions, contact your health care provider.

What can I expect after the procedure?

After the procedure, it is common:

• To have some soreness or discomfort around the incision in your chest.
• To feel more tired than usual.
• To feel emotional or irritable.

Follow these instructions at home:

Incision care

• Follow instructions from your health care provider about how to take care of your incision. Make sure you:
  • Wash your hands with soap and water before you change your bandage (dressing). If soap and water are not available, use hand sanitizer.
  • Change your dressing as told by your health care provider.
  • Leave stitches (sutures), skin glue, or adhesive strips in place. These skin closures may need to stay in place for 2 weeks or longer. If adhesive strip edges start to loosen and curl up, you may trim the loose edges. Do not remove adhesive strips completely unless your health care provider tells you to do that.
• Check your incision area every day for signs of infection. Check for:
  • Redness, swelling, or pain.
  • Fluid or blood.
  • Pus or a bad smell.
  • Warmth.
• Do not take baths, swim, or use a hot tub until your health care provider approves. Ask your health care provider if you may take showers. You may only be allowed to take sponge baths.

Medicines

• Take all over-the-counter and prescription medicines exactly as told by your health care provider. Do not stop taking these medicines. Ask your health care provider what side effects to look for.
• Develop a routine to make sure you take all your medicines correctly and at the right time each day.
• You will need to take medicines to keep your body from rejecting the donor heart (immunosuppressants) for the rest of your life.
• If you were prescribed an antibiotic medicine, take it as told by your health care provider. Do not stop taking the antibiotic even if you start to feel better.

Eating and drinking

• Eat a heart-healthy diet. This includes plenty of fruits and vegetables, lean proteins, low-fat dairy, and whole grains. Avoid foods that are high in salt (sodium), sugar, and saturated fat.
• Drink enough fluid to keep your urine pale yellow.
• Do not eat raw or undercooked foods. These increase the risk of infection.
• Ask your health care provider about certain foods or beverages that you should avoid.
• Limit alcohol intake as told by your health care provider.

Activity

• Return to your normal activities as told by your health care provider. Ask your health care provider what activities are safe for you.
• You may need to limit vigorous exercise at the beginning of your recovery.
• Talk to your health care provider before starting a new exercise routine.

Safety

• Your medicines may raise your risk of infection. Make sure you:
  • Wash your hands often with soap and warm water.
  • Avoid contact with people who are sick.
• Tell your close friends and family members to wash their hands often with soap and warm water.
• Do not share utensils, cups, or toothbrushes with other people.
• Do not handle animal waste, including cat litter.
• Make sure all of your pets are healthy and up to date on vaccines.
• Avoid pets such as reptiles, birds, hamsters, frogs, and guinea pigs. These animals can carry bacteria that may make you sick.
• Always wear gloves while working in your yard or garden.
• Take care to protect yourself from the sun. This includes:
  • Wearing sunscreen (SPF 30 or higher).
  • Avoiding outdoor activities when the sun is strongest (between 10 a.m. and 4 p.m.).
  • Wearing a wide-brimmed hat and sunglasses.
• Ask your health care provider when it is safe for you to get a flu shot and other vaccines. Ask if there are any vaccines you should not get.

Watching for symptoms of organ rejection

Know the symptoms of organ rejection. Rejection happens most often in the first few months after surgery. Symptoms of rejection include:

• Fever of 100.5°F (38°C) or higher.
• Increased fatigue.
• Rapid breathing.
• Shortness of breath.
• Rapid or irregular heartbeat.
• Sudden weight gain—4 lb (1.8 kg) within 24 hours.
• Swelling in the hands, feet, or ankles.
• Loss of appetite.
• Nausea or vomiting.
• Flu-like symptoms such as chills, aches, or headache.

General instructions

• Learn as much as you can about your condition.
• Do not use any products that contain nicotine or tobacco, such as cigarettes and e-cigarettes. If you need help quitting, ask your health care provider.
• Talk to your health care provider if you are having any emotional problems during your recovery, such as sadness, stress, or anxiety.
• If you are a woman who plans to become pregnant, talk to your health care provider first. Women who undergo a heart transplant can face complications during pregnancy.
• Keep all follow-up visits as told by your health care provider. This is important. You will need frequent return visits for blood tests, heart function tests, and heart imaging tests.

Contact a health care provider if:

• You miss a dose of your medicine.
• You are not able to take your medicines because you are ill.
• You are having side effects from your medicines.
• You feel depressed or anxious.
• You have chills or a fever.
• Your incision shows signs of infection, such as:
  • Redness, swelling, or pain.
  • Fluid or blood.
  • Pus or a bad smell.
  • Warmth.
• You have symptoms of an infection. This may include:
  • Cough.
  • Congestion.
  • Sore throat.
  • Diarrhea.
  • Skin or mouth sores.
  • Burning pain when urinating.

Get help right away if:

• You have trouble breathing.
• You are extremely tired.
• Your skin becomes pale, clammy, or blue.
• You have any symptoms of organ rejection.

Summary

• Take all over-the-counter and prescription medicines exactly as told by your health care provider.
• Maintain good hygiene to reduce your risk of infection.
• Know the symptoms of organ rejection. Contact your health care provider right away if you have any of these symptoms.