Most heart transplants are done on patients who have end-stage heart failure, a condition in which your heart is severely damaged or weakened, and on people who have failed other treatment options. End-stage heart failure may be caused by conditions such as coronary heart disease, viral infections, or hereditary conditions. In rare instances, heart transplant may be performed at the same time as lung transplant in patients who have severe heart and lung disease.
You may be eligible for heart transplant surgery if you have severe heart disease that does not respond to other treatments. If you are otherwise healthy enough for surgery, you will be placed on the National Organ Procurement and Transplantation Network’s waiting list. This national network handles the organ-sharing process for the United States. If a match is found, you will need to have your heart transplant surgery right away.
Heart transplant surgery will be done in a hospital. You will have general anesthesia and will not be awake during the surgery. You will receive medicine through an intravenous (IV) line in your arm. A breathing tube connected to a ventilator will help you breathe. A surgeon will open your chest, connect your heart’s arteries and veins to a heart-lung bypass machine, and remove your diseased heart. The body’s arteries and veins will be taken off the bypass machine and reconnected to the healthy donor heart. The heart transplant is complete after the surgeon closes your chest.
After the surgery, you will recover in the hospital’s intensive care unit (ICU) and stay in the hospital for up to three weeks. During your recovery, you may start a cardiac rehabilitation program. Before leaving the hospital, you will learn how to keep track of your overall health; monitor your weight, blood pressure, pulse, and temperature; and learn the signs of heart transplant rejection and infection. For the first three months after leaving the hospital, you will return often for tests to check for infection or rejection of your new heart, to test your heart function, and to make sure that you are recovering well.
Practicing good hygiene, obtaining routine vaccines, and making healthy lifestyle choices are very important after a heart transplant to reduce your risk of infection. Regular dental care is also important. Your doctor or dentist may prescribe antibiotics before any dental work to prevent infection. Following your doctor’s advice will help you recover and stay as healthy as possible.
Heart transplant has some serious risks. Primary graft dysfunction happens when the donor heart fails and cannot function. This is the most frequent cause of death for the first month after transplant. Your immune system also may reject your new heart. Rejection is most likely to occur within six months after the transplant. You will need to take medicines for the rest of your life to suppress your immune system and help prevent your body from rejecting your new heart. These medicines weaken your immune system and increase your chance for infection. Their long-term use also can increase your risk for cancer, cause diabetes and osteoporosis, and damage your kidneys. Cardiac allograft vasculopathy is a common and serious complication of heart transplant. Cardiac allograft vasculopathy is an aggressive form of atherosclerosis that over months or a few years can quickly block the heart’s arteries and cause the donor heart to fail. Over time, your new heart may fail due to the same reasons that caused your original heart to fail. Some patients who have a heart transplant that fails may be eligible for another transplant.
Despite these risks, heart transplant has a good success rate that has improved over many decades of research. Recent survival rates are about 85 percent at one year after surgery, with survival rates decreasing by about three to four percent each additional year after surgery because of serious complications. Mechanical circulatory support, possibly from left ventricular assist devices, may be an alternative to heart transplant. But more research is needed to determine long-term survival rates for these new devices.