Heart transplant

Surgery Overview

A heart transplant is a procedure in which a surgeon removes a diseased heart and replaces it with a donor heart. During a heart transplant, a mechanical pump circulates blood through the body while the surgeon removes the diseased heart and replaces it with a healthy heart from a recently deceased donor.

The surgeon connects the donor heart to the major blood vessels and hooks the heart up to wires that temporarily control the heartbeat. The procedure takes several hours.

To prevent the body from rejecting the donor heart, your surgeon will give you powerful drugs (immunosuppressants) immediately after surgery, and you must continue to take them.

What To Expect After Surgery

After a heart transplant, the recovery process is similar to the process after other heart surgeries. People who receive transplants often need a cardiac rehabilitation program, because long-term heart failure is usually present.

You will spend about 1 to 2 weeks in the hospital after surgery. You may have to stay longer depending on your health and if you have complications from surgery. While in the hospital, you will start rehabilitation. And your doctors will check on your heart to make sure your body is not rejecting it.

Why It Is Done

A heart transplant is an option when the heart no longer works well enough and a person is at risk of dying. A heart transplant may be considered when a person has severe heart disease and is likely to benefit most from a donor heart. A person might be a candidate for a transplant when any of these conditions are true:

• The person has end-stage heart failure, ischemic heart disease, cardiomyopathy, or congenital heart disease.
• The person has a low chance of living as long as 1 year without a heart transplant.
• The person has no other serious medical conditions that would reduce his or her life expectancy.
• The doctor strongly expects that a heart transplant will increase survival and improve the person's quality of life.

At some centers, transplant candidates must demonstrate that they have quit smoking and/or overusing alcohol for a period of time (such as 4 to 6 months) before they are considered for placement on a transplant waiting list.

How Well It Works

In carefully selected people, a heart transplant can be very successful.

About 81% of all people who receive heart transplants survive for at least 1 year. About 75% survive 3 years, and 68% survive 5 years. About 50% survive 10 years.¹

Risks

Risks from heart transplant include:

• Rejection of the donor heart.
  • To check for rejection, every 3 to 4 months surgeons test a sample (biopsy) of the heart tissue and also perform echocardiography, electrocardiography (ECG, EKG), or blood tests.
  • If your body rejects the heart, you will receive additional drugs (such as immunosuppressants or steroids) to suppress your immune system so that it does not reject the donor heart. These additional drugs may have serious side effects, including an increased risk of infections and cancer.
• Other risks, such as:
  • Side effects (for example, infections, ulcers, or bone loss) that may occur from steroid therapy used to suppress the immune system.
  • Side effects that may occur from a drug (cyclosporine) given to prevent rejection of the donor heart.
  • Clogging of the arteries (atherosclerosis) that may develop in the donor heart. (This is usually a complication and is an important limiting factor that affects long-term survival.)
• Death.

What To Think About

After a heart transplant, you must follow a strict lifestyle involving daily medicines and regular medical care, which includes regular sampling (biopsies) of the transplanted heart tissue to check for rejection.

You may wait a year or longer for a donor heart. However, with maximal medical therapy, more than half of people on waiting lists survive for an extended period of time.

Candidates receive a donor heart according to the:

• Date they were placed on the waiting list.
• Severity of their heart failure symptoms.

There are limited donor hearts available.

Complete the surgery information form (PDF) (What is a PDF document?) to help you prepare for this surgery.

Author:	Robin Parks, MS	Last Updated: August 25, 2008
Medical Review:	Caroline S. Rhoads, MD - Internal Medicine Robert A. Kloner, MD, PhD - Cardiology
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