A heart transplantation involves replacing a diseased heart with a donor heart in cases where there is end-stage disease.  Note: patients will be on immunosuppression for life after the surgery.  Causes include: coronary artery disease, cardiomyopathy, congestive heart failure, heart valve disease, congenital heart disease, and cardiac arrhythmias.  A patient must first be put on the transplant list to qualify.  Candidates will discuss qualify of life issues, advantages, and disadvantages with the cardiologist and then undergo a series of physical tests.  A committee will then review the patient's profile to determine if he/she is able to undergo the procedure.  

Pre-Operative Details:

Your surgeon will give specific instructions before the surgery, including risks (i.e. bleeding, infection, adverse reaction to anesthesia, etc.).  Please make sure to contact your insurance company for coverage.  A social worker and/or hospital finance worker will meet and work with you and your family in sorting out the costs of this procedure.  You will be on a waiting list for a heart transplant after the committee approves you.  You will also meet with the anesthesiologist prior to the surgery to go over your medical history.  Please do not eat after midnight the night before your surgery.  On the day of surgery, you will arrive at the hospital, get registered, and get changed into a hospital gown.  A nurse will then review your chart to make sure there are no problems and then get all the paperwork in order for surgery.  The anesthesiologist will then start an IV and you will be taken to the operating room, where the surgeon will verify your name and procedure before any medication is given.  Once you are under anesthesia, surgery will begin.

Operative Details:

The surgeon will make a long incision in the chest on the side in between ribs and then spread the ribs to access the lungs.  The patient will also be placed on blood thinners to prevent clot formation during the surgical manipulations.  A cardiopulmonary bypass will be placed to pump blood to the rest of the body without using the lungs.  The blood is taken into the machine from the inferior vena cava and superior vena cava and then sent back into the aorta.  The diseased heart is removed from the body and the donor heart is stitched into place.  The donor heart will be matched by certain genes to the recipient to minimize rejection risks.  Once the donor heart is attached and working, the patient will come off the bypass machine and the chest is closed with stitches/staples.  

Post-Operative Details:

After the surgery, you will be taken to the intensive care unit and be monitored.  You will have a breathing tube in place until you are able to breath on your own.  Note: with this tube in place, you also will not be able to speak.  You will also have multiple tubes and IVs attached until you condition is stable.  You will likely experience pain and will given pain medication appropriately.  It is important to keep the incision areas clean and dry.  The length of your hospital stay depends on how quickly you are able to recover and perform some physical activity.  If you experience fevers, severe pain, redness/swelling/warmth where the incisions were made, or drainage from the incisions, please let your doctor know immediately.  Your surgeon will give specific instructions about recovery time.