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Heart transplant surgery

What is it?
Heart transplant surgery is the removal of a failing heart and pre-existing hardware (such as an implantable cardio defibrillator or pacemakers) and its replacement by a donor heart.

Why is it performed?
Heart transplant is used to treat severe, end-stage heart failure. This heart failure may be the result of damage to the heart from:

  • Coronary artery disease, such as a heart attack.
  • Severe, untreated hypertension (hypertensive heart disease).
  • Heart valve problems.
  • Infections, such as viruses.
  • Alcohol and illicit drug use.
  • Inherited heart disease.
  • Congential heart disease (a malformation of the heart a person is born with).
  • Unknown (idiopathic).

For severely ill patients, a mechanical heart (mechanical assist device) may be used temporarily while waiting for a donor heart.

What is done?
During the operation, a bypass machine will be used to pump blood to the rest of your body. Most of the old, failing heart will be removed. The posterior walls of both upper chambers (atria) are left in place and the new heart is attached to this remaining tissue. The blood vessels leading in and out of the heart are also attached to the new heart. (As a precaution, pacing wires may be placed on the surface of the heart, which can be connected to an external pacemaker, if necessary. Prior to discharge, these wires will be removed.) The new heart is then shocked so it will start beating and the chest is closed.

What you can expect
Once it is determined that you require a new heart, you will be evaluated to determine whether you are a good candidate for heart transplant. If you are, your name will be put on the heart transplant waiting list. Your position on the list will depend upon how ill you are, and may be moved up over time if your health changes. Once on the waiting list, you will receive a pager so you can be contacted immediately when a suitable heart becomes available. Since the donor heart has to be transplanted within hours of donation, you may want to stay prepared by making a travel plan ahead and packing a suitcase with your medication for a hospital stay.

Preparation for surgery includes blood work, an electrocardiogram (ECG), a chest X-ray, a urine sample, and the insertion of an intravenous line for measuring pressure in the lung arteries.

A transplant is conducted under a general anesthetic so you will be asleep throughout the procedure. Once you are sedated, the surgeons will place:

  • a tube down your windpipe, which will be connected to a breathing machine called a respirator to support your breathing during the surgery.
  • a tube into your stomach to stop liquid and air from collecting in your stomach so you will not feel sick and bloated when you wake up.
  • a tube into your bladder to collect urine.

The surgery usually takes about 3 to 5 hours, but it can vary. When you awaken, you will be in the intensive care unit (ICU) or cardiovascular intensive care unit (CVICU). Once you are awake and able to breathe adequately, you will be detached from the ventilator and the tube down your windpipe will be removed. Pain medication will be given to you, either intravenously or as pills. As you recover, you will be transferred to a step-down unit and then to a regular room.

You can expect to stay in the hospital at least two to three weeks after surgery. Drugs to suppress your immune system (immunosuppressive therapy) will be administered to prevent your body from rejecting the donor heart. A rehabilitation program will be designed to help your recovery.

Upon returning home, you should watch for possible signs of infection, such as fever, sore throat, shortness of breath, coughing, cold sores, flu-like symptoms or feeling unwell, or redness, swelling or drainage from your incision. Possible signs of rejection of the donor heart include shortness of breath, weight gain, fever and fatigue. Most patients continue to receive follow-up care for several months after they return home.

Last reviewed: June 2012
Last modified: July 2012