Heart Transplant – Procedure, Risk and Treatments

Heart Transplant – Procedure, Risk and Treatments

What is a Heart Transplant?

Heart transplant is a major operation of replacing a diseased heart from a person with a healthy heart from an organ donor. A person can only donate their heart once they have been declared brain-dead. And their family has agreed to donate the organs of their loved one’s. 

Heart transplant is done only when the patient’s health does not get better after trying multiple other treatment methods or medication. However, once you get a heart transplant, you can live a good and healthy life, if you follow the doctor’s instructions and take your medication on time. 

What are the reasons for getting a Heart Transplant?

A heart transplant is major surgery. It is not the first treatment option for a patient suffering from heart diseases. However, if your heart is failing and all the other treatments have failed, then your doctor might recommend you to get a heart transplant. Various reasons can cause heart failure, such as-

• Heart attack (myocardial infarction)
• High blood pressure 
• Heart valve disease 
• Heart muscle infection 
• Heart defects since birth (congenital heart)
• Irregular rhythms or heartbeats (arrhythmias)
• Substance abuse 
• Lung disease 
• Low red blood cell count
• Heart muscle infection 
• Thick, stiff and enlarged heart muscle (cardiomyopathy)
• Low red blood cell count (anemia)

Who cannot have a Heart Transplant?

Sometimes, getting a heart transplant is not the right option for you. Since it is major surgery, your body bears a lot of strain, which may risk your life and thus outweigh transplant’s potential benefits. 

You may not be able to get a heart transplant if you are-

• Old, above the age of 65
• Excessive substance abuse 
• Blood vessels damaged due to diabetes
• Have an active infection
• Have other diseases related to liver, kidney, lungs or nerves
• Have cancer or have overcome it recently 

Heart Transplant Procedure

Before the procedure

Before you are selected as an appropriate candidate for heart transplant, your doctor will ask you to get a couple of tests done and will also review your medical history to determine your condition. The tests include psychological tests, blood tests, and diagnostic tests. The blood tests will make it easier to find a donor heart that matches your blood type to avoid the risk of your body rejecting the new heart. Through diagnostic tests including X-rays, ultrasounds, CT scans, etc, your overall health will be checked.      

Waiting for a Donor Heart

Once your doctor has approved you as an eligible candidate for heart transplant, you will be put on a waiting list. Sadly, the number of patients for heart transplant exceeds the number of donor hearts available so the waiting time for getting a heart transplant might be long. It also depends upon the size of your heart, your blood type, and the severity of the heart disease.

During the transplant 

• Once you are ready for the surgery, you will be given general anesthesia, which will put you in a deep sleep till the transplant is over.
• Your body will be connected with a heart lung bypass machine. This machine will maintain the flow of oxygen rich blood in the body, even when the heart is being operated. 
• Using a sharp tool, the surgeon will make an incision in your chest. The surgeon will then cut the chest bone to reach your diseased heart.
• The heart will be removed except for its upper 2 chambers, and the back walls of the atria.
• The new heart will be then placed at the newly vacated spot and will be connected with the blood vessels, and the blood will be able to flow through the heart and lungs.
• Once the heart starts beating, the bypass machine will be removed. 
• The chest bone will be closed and the sin and tissues will be closed with the help of tissues.
• Heart transplant surgery is an open heart surgery and takes a lot of time, around 4 to 10 hours.

After the transplant 

• After the surgery, you will be put in an Intensive Care Unit for continuous monitoring to see that your heart is working properly. 
• The nurse will keep a check on your blood pressure, breathing rate, oxygen level, and other vitals via machines connected to you. 
• You will be put on a ventilator for a few days. This ventilator will help you to breathe. Gradually, as you start breathing yourself, the machine will be adjusted accordingly to allow you to breathe on your own. 
• Initially, a tube will be inserted into your mouth to give fluids and other nutrients to the body.
• After getting a heart transplant, you might have to daty in the hospital for one to two weeks depending upon your recovery rate and other factors. 
• When the doctor thinks that you are recovered enough, you will be sent back home with clear instructions regarding the medication and follow-up visits.

What are the risks associated with a Heart Transplant?  

Since heart transplant surgery is a major operation, there are risks of certain complications that could occur at any time. Some of these complications might take place a few days after the transplant while others might take months or even years. 

These risks are-

• Donor heart rejection 

Rejection of the donor heart is one of the most common and significant risks associated with a heart transplants. Your immune system might see the donor heart as a foreign body and fight against it like it does with any other virus or bacteria that enters the body. This can damage the heart. To prevent the immune system from doing so, you have to take immunosuppressants for the rest of your life. They can reduce the risk of rejection by weakening your immune system but cannot always prevent it from happening.

To ensure that your heart is working properly, you will have to visit your doctor frequently to get biopsies done (till at least the first year of transplant).

During Biopsy, a tube is inserted inside a vein through the neck or groin and directed to the heart. And a biopsy device, which runs through the tube takes a small sample of heart tissue for examination in a lab.

• Graft Failure 

There are certain cases in which, soon after the transplant the donor heart fails and stops working properly. This condition is what causes the most frequent deaths during the first few months of transplant.

• Problems in arteries 

After the heart transplant, there is a possibility of thickening and hardening of the blood vessels connected to the new heart, leading to cardiac allograft vasculopathy (CAV). This is a long-term condition, which might make it difficult for the blood to reach your heart and could lead to a heart attack, heart arrhythmias, or sometimes even a sudden cardiac death. 

• Side effects of medication 

There are certain risks you may face due to the immunosuppressants you’ll have to take for the rest of your life to prevent rejection of the donor heart. There is a risk of – kidney damage, increased risk of infections and cancer, diabetes, osteoporosis, weight gain and high blood pressure. 

If you notice any of the following symptoms, you should immediately contact your doctor- 

• Fever, chills
• Low blood pressure
• Chest pain
• Extreme tiredness
• Pain, redness, swelling or bleeding at the incision site
• Difficulty in breathing

These could be signs of rejection or infection and should be treated as soon as possible to avoid further damage.

After care

To increase the possibility of healthy life after getting a heart transplant surgery, there are certain lifestyle changes you will have to make. Such as-

• Proper medication

Make sure that you take all the medicines as per your doctor’s instructions. These immunosuppressants will prevent the body from rejecting your new heart. However, they cause other problems in the body like creating a risk of – high BP, kidney damage, weakening of bones, increased risk of infections and cancer and much more. Additional medication is prescribed to combat these. 

• Follow up appointments 

Never miss a follow up appointment with your doctor, as they will check the functioning of the transplanted heart and see to it that no complications have risen. You might have frequent follow-up appointments in the beginning after the transplant, however as the time passes the frequency of visits will decrease. 

• Exercise 

If you have gotten a heart transplant, you are recommended to exercise regularly to keep the transplanted heart healthy and to avoid weight gain. However, since a transplant heart beats faster (100-110 beats per minute) than a normal heart (approximately 70 beats per minute), you should consult your doctor or a physiotherapist regarding the type of exercise most beneficial for you. Exercising will also help you increase your strength and mobility to a great extent. 

• Diet 

A balanced diet is very beneficial after getting a heart transplant surgery as it will make the body heal faster and keep you healthy. It might also help reduce the side effects of immunosuppressants like- weight gain, high blood pressure, diabetes and osteoporosis. 

FAQs 

Q-1. What is the heart transplant cost?

Ans. The cost of a heart transplant can vary anywhere between 20 – 25 lakhs. This includes pre-transplant evaluation, the surgery itself, and the post-transplant recovery period.

Q-2. How long can you live after a heart transplant?

Survival rates after heart transplantation vary based on several factors. Survival rates remain 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. 

Q-3. What is the success rate of heart transplant?

Ans. Around 85-90% of heart transplant patients live up to one year after their surgery. The yearly death rate after one year is 4%. The one-year survival rate in people with congenital heart disease is 79%.