Heart Transplant

A heart transplant is an operation in which a diseased, failing heart is replaced with a healthier donor heart. Heart transplant is a treatment that's usually reserved for people whose condition hasn't improved enough with medications or other surgeries. While a heart transplant is a major operation, your chance of survival is good with appropriate follow-up care.

RESULTS
Most people who receive a heart transplant enjoy a good quality of life. Depending on your condition, you may be able to resume many of your daily life activities, such as returning to work, participating in hobbies and sports, and exercising. Discuss with your doctor what activities are appropriate for you.

Some women who have had heart transplants can become pregnant. However, talk to your doctor if you're considering having children after your transplant. You'll likely need medication adjustments before becoming pregnant, as some medications can cause pregnancy complications.

Survival rates after heart transplantation vary based on a number of factors. Survival rates continue to improve despite an increase in older and higher risk heart transplant recipients. Worldwide, the overall survival rate is more than 85% after one year and about 69% after five years for adults.
DIET AND NUTRITION
After your heart transplant, you may need to adjust your diet to keep your heart healthy and functioning well. Maintaining a healthy weight through diet and exercise can help you avoid complications such as high blood pressure, heart disease and diabetes.

A nutrition specialist (dietitian) can discuss your nutrition and diet needs and answer any questions you have after your transplant. Your dietitian will provide you with several healthy food options and ideas to use in your eating plan. Your dietitian's recommendations may include:

·        Eating plenty of fruits and vegetables each day
·        Eating whole-grain breads, cereals and other grains
·        Drinking low-fat or fat-free milk or eating other low-fat or fat-free dairy products, to help maintain enough calcium in your body
·        Eating lean meats, such as fish or poultry
·        Maintaining a low-salt diet
·        Avoiding unhealthy fats, such as saturated fats or trans fats
·        Avoiding grapefruit and grapefruit juice due to its effect on a group of immunosuppressant medications (calcineurin inhibitors)
·        Avoiding excessive alcohol
·        Staying hydrated by drinking adequate water and other fluids each day
·        Following food safety guidelines to reduce the risk of infection
AFTER THE PROCEDURE
TAKING IMMUNOSUPPRESSANTS.

These medications decrease the activity of your immune system to prevent it from attacking your donated heart. You'll take some of these medications for the rest of your life. Because immunosuppressants render your body more vulnerable to infection, your doctor might also prescribe antibacterial, antiviral and antifungal medications. Some drugs could worsen — or raise your risk of developing — conditions such as high blood pressure, high cholesterol, cancer or diabetes. Over time, as the risk of rejection decreases, the doses and number of anti-rejection drugs can be reduced.

MANAGING MEDICATIONS, THERAPIES AND A LIFELONG CARE PLAN.

After a heart transplant, taking all your medications as your doctor instructs and following a lifelong care plan are vital. Your doctor might give you instructions regarding your lifestyle, such as wearing sunscreen, not using tobacco products, exercising, eating a healthy diet and being careful to lower your risk of infection. Follow all of your doctor's instructions, see your doctor regularly for follow-up appointments, and let your doctor know if you have signs or symptoms of complications. It's a good idea to set up a daily routine for taking your medications so that you don't forget. Keep a list of all your medications with you at all times in case you need emergency medical attention, and tell all your doctors what you take each time you're prescribed a new medicine.

CARDIAC REHABILITATION.

These programs incorporate exercise and education to help you improve your health and recover after a heart transplant. Cardiac rehabilitation, which you might start before you're released from the hospital, can help you regain your strength and improve your quality of life.
THE PROCEDURE
Heart transplant surgery is an open-heart procedure that takes several hours. If you've had previous heart surgeries, the surgery is more complicated and will take longer.

You'll receive medication that causes you to sleep (general anesthetic) before the procedure. Your surgeons will connect you to a heart-lung bypass machine to keep oxygen-rich blood flowing throughout your body.

Your surgeon will make an incision in your chest. Your surgeon will separate your chest bone and open your rib cage so that he or she can operate on your heart.

Your surgeon then removes the diseased heart and sews the donor heart into place. He or she then attaches the major blood vessels to the donor heart. The new heart often starts beating when blood flow is restored. Sometimes an electric shock is needed to make the donor heart beat properly.

You'll be given medication to help with pain control after the surgery. You'll also have a ventilator to help you breathe and tubes in your chest to drain fluids from around your lungs and heart. After surgery, you'll also receive fluids and medications through intravenous (IV) tubes.
RISKS
Besides the risks of having open-heart surgery, which include bleeding, infection and blood clots, risks of a heart transplant include:

REJECTION OF THE DONOR HEART.

One of the most significant risks after a heart transplant is your body rejecting the donor heart. Your immune system may see your donor heart as a foreign object and try to reject it, which can damage the heart. Every heart transplant recipient receives medications to prevent rejection (immunosuppressants), and as a result, the rate of rejection continues to decrease. Sometimes, a change in medications will halt rejection if it occurs. To help prevent rejection, it's critical that you always take your medications as prescribed and keep all your appointments with your doctor.

Rejection often occurs without symptoms. To determine whether your body is rejecting the new heart, you'll have frequent heart biopsies during the first year after your transplant. After that, you won't need biopsies as often. During the biopsy, a tube is inserted into a vein in your neck or groin and directed to your heart. A biopsy device is run through the tube to take a tiny sample of heart tissue, which is examined in a lab.

PRIMARY GRAFT FAILURE.

With this condition, the most frequent cause of death in the first few months after transplant, the donor heart doesn't function.

PROBLEMS WITH YOUR ARTERIES.

After your transplant, it's possible that the walls of the arteries in your heart could thicken and harden, leading to cardiac allograft vasculopathy. This can make blood circulation through your heart difficult and can cause a heart attack, heart failure, heart arrhythmias or sudden cardiac death.

MEDICATION SIDE EFFECTS.

The immunosuppressants you'll need to take for the rest of your life can cause serious kidney damage and other problems.

CANCER.

Immunosuppressants can also increase your risk of developing cancer. Taking these medications can put you at a greater risk of skin and lip tumors and non-
Hodgkin's lymphoma, among others.

INFECTION.

Immunosuppressants decrease your ability to fight infection. Many people who have heart transplants have an infection that requires them to be admitted to
the hospital in the first year after their transplant.

Treatments

HEART TRANSPLANT
The procedure actually consists of three operations. THE FIRST operation is harvesting the heart from the donor. The donor is usually an unfortunate person who has suffered irreversible brain injury, called "brain death". Very often these are patients who have had major trauma to the head, for example, in an automobile accident. The victim's 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 SECOND operation is removing the recipient's damaged heart. Removing the damaged heart may be very easy or very difficult, depending on whether the recipient has had previous heart surgery (as is often the case). If there has been previous surgery, cutting through the scar tissue may prolong and complicate removal of the heart. THE THIRD operation is probably the easiest; the implantation of the donor heart. Today, this operation basically involves the creation of only five lines of stitches, or "anastomoses". These suture lines connect the large blood vessels entering and leaving the heart. Remarkably, if there are no complications, most patients who have had a heart transplant are home about one week after the surgery. The generosity of donors and their families makes organ transplant possible. View

HEART TRANSPLANT

The procedure actually consists of three operations.

THE FIRST operation is harvesting the heart from the donor. The donor is usually an unfortunate person who has suffered irreversible brain injury, called "brain death". Very often these are patients who have had major trauma to the head, for example, in an automobile accident. The victim's 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 SECOND operation is removing the recipient's damaged heart. Removing the damaged heart may be very easy or very difficult, depending on whether the recipient has had previous heart surgery (as is often the case). If there has been previous surgery, cutting through the scar tissue may prolong and complicate removal of the heart.

THE THIRD operation is probably the easiest; the implantation of the donor heart. Today, this operation basically involves the creation of only five lines of stitches, or "anastomoses". These suture lines connect the large blood vessels entering and leaving the heart. Remarkably, if there are no complications, most patients who have had a heart transplant are home about one week after the surgery. The generosity of donors and their families makes organ transplant possible.

View

VENTRICULAR ASSIST DEVICES
For some people who cannot have a heart transplant, another option may be a ventricular assist device (VAD). A ventricular assist device is a mechanical pump implanted in your chest that helps pump blood from the lower chambers of your heart (ventricles) to the rest of your body. VADs are commonly used as temporary treatments for people waiting for heart transplants. These devices are increasingly being used as long-term treatments for people who have heart failure but are not eligible for heart transplants. If a VAD doesn't help your heart, doctors may sometimes consider a total artificial heart — a device that replaces the ventricles of your heart — as an alternative short-term treatment while you're waiting for a heart transplant. View

VENTRICULAR ASSIST DEVICES

For some people who cannot have a heart transplant, another option may be a ventricular assist device (VAD). A ventricular assist device is a mechanical pump implanted in your chest that helps pump blood from the lower chambers of your heart (ventricles) to the rest of your body.

VADs are commonly used as temporary treatments for people waiting for heart transplants. These devices are increasingly being used as long-term treatments for people who have heart failure but are not eligible for heart transplants. If a VAD doesn't help your heart, doctors may sometimes consider a total artificial heart — a device that replaces the ventricles of your heart — as an alternative short-term treatment while you're waiting for a heart transplant.

View