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Heart Transplant

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) right after surgery. You must continue to take them.

Heart transplant

Diseased heart showing where blood vessels were detached and transplanted heart showing where blood vessels were attached

For a heart transplant, the diseased heart is removed and replaced with the donated heart. During the surgery, a mechanical pump moves blood through the body.

  • Why It's Done

    Why is heart transplant surgery 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 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.

  • Before Transplantation

    How do you prepare for heart transplant surgery?

    Surgery can be stressful. This information will help you understand what you can expect. And it will help you safely prepare for surgery.

    Preparing for surgery

    • Be sure you have someone to take you home. Anesthesia and pain medicine will make it unsafe for you to drive or get home on your own.
    • Understand exactly what surgery is planned, along with the risks, benefits, and other options.
    • If you take aspirin or some other blood thinner, ask your doctor if you should stop taking it before your surgery. Make sure that you understand exactly what your doctor wants you to do. These medicines increase the risk of bleeding.
    • Tell your doctor ALL the medicines, vitamins, supplements, and herbal remedies you take. Some may increase the risk of problems during your surgery. Your doctor will tell you if you should stop taking any of them before the surgery and how soon to do it.
    • Make sure your doctor and the hospital have a copy of your advance directive. If you don’t have one, you may want to prepare one. It lets others know your health care wishes. It’s a good thing to have before any type of surgery or procedure.
  • Preparing for Heart Transplant

    What happens on the day of your heart transplant surgery?

    • Follow the instructions exactly about when to stop eating and drinking. If you don’t, your surgery may be canceled. If your doctor told you to take your medicines on the day of surgery, take them with only a sip of water.
    • Take a bath or shower before you come in for your surgery. Do not apply lotions, perfumes, deodorants, or nail polish.
    • Do not shave the surgical site yourself.
    • Take off all jewelry and piercings. And take out contact lenses, if you wear them.

    At the hospital or surgery center

    • Bring a picture ID.
    • You will be kept comfortable and safe by your anesthesia provider. You will be asleep during the surgery.
    • The surgery will take at least 4 hours.
    • You will have a breathing tube down your throat. This is usually removed within 6 hours after surgery. You will not be able to talk or drink liquids while the tube is in your throat. After the tube is removed, your throat will feel dry and scratchy. Your nurse will tell you when it is safe to drink liquids again.
    • You will have a thin plastic tube, called a catheter, in a vein in your neck. It is used to keep track of how well your heart is working. This is usually removed in 1 to 3 days.
    • You will have chest tubes to drain fluid and blood after surgery. The fluid and extra blood are normal and usually last only a few days. The chest tubes are usually removed in 1 or 2 days.
    • You will have several thin wires coming out of your chest near your incision. These wires can help keep your heartbeat steady after surgery. They will be removed before you go home.
  • Risks

    What are the risks of heart transplant surgery?

    Risks from heart transplant include:

    • Rejection of the donor heart.
      • To check for rejection, surgeons will regularly test a sample (biopsy) of the heart tissue. They'll also do echocardiography, electrocardiography (ECG, EKG), or blood tests.
      • If your body rejects the heart, you will receive other drugs (such as immunosuppressants or steroids) to suppress your immune system so that it does not reject the donor heart. These drugs may have serious side effects, including an increased risk of infections and cancer.
    • Infection.
    • Clogging of the arteries (atherosclerosis) that may develop in the donor heart. (This is usually a complication and can affect long-term survival.)
    • Death.
  • Your Recovery

    Heart transplant: Your recovery

    A heart transplant is surgery in which your diseased heart is replaced with a healthy donor heart. Your doctor did the surgery through a cut (incision) in your chest.

    You will feel tired and sore for several weeks after surgery. You may have some brief, sharp pains on either side of your chest. Your chest, shoulders, and upper back may ache. The incision in your chest may be sore or swollen. These symptoms usually get better after 4 to 6 weeks.

    You will probably be able to do many of your usual activities after about 3 months. But for 3 to 4 months, you will not be able to lift heavy objects or do activities that strain your chest or upper arm muscles. At first you may notice that you get tired easily and need to rest often. It may take several months to get your energy back.

    Having an organ transplant can bring up many emotions. You may feel grateful and happy. But you also may feel guilty or depressed. Seek out family, friends, and counselors for support. If you think you are depressed, ask your doctor for help. Treatment can help you feel better.

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

    You probably started a cardiac rehabilitation (rehab) program in the hospital. You will continue with this rehab program after you go home to help you recover and prevent problems with your heart.

  • After Transplant: When To Call

    After a heart transplant: When to call

    Call 911 anytime you think you may need emergency care. For example, call if:

    • You passed out (lost consciousness).
    • You have severe trouble breathing.
    • You have sudden chest pain and shortness of breath, or you cough up blood.
    • You have severe pain in your chest.
    • You have symptoms of a heart attack. These may include:
      • Chest pain or pressure, or a strange feeling in the chest.
      • Sweating.
      • Shortness of breath.
      • Nausea or vomiting.
      • Pain, pressure, or a strange feeling in the back, neck, jaw, or upper belly or in one or both shoulders or arms.
      • Lightheadedness or sudden weakness.
      • A fast or irregular heartbeat.
      After you call 911, the operator may tell you to chew 1 adult-strength or 2 to 4 low-dose aspirin. Wait for an ambulance. Do not try to drive yourself.

    Call your doctor now or seek immediate medical care if:

    • You have pain that does not get better after you take pain medicine.
    • You have loose stitches, or your incision comes open.
    • Bright red blood has soaked through the bandage over your incision.
    • You have signs of infection, such as:
      • Increased pain, swelling, warmth, or redness.
      • Red streaks leading from the incision.
      • Pus draining from the incision.
      • Swollen lymph nodes in your neck, armpits, or groin.
      • A fever.
    • You have signs of a blood clot, such as:
      • Pain in your calf, back of the knee, thigh, or groin.
      • Redness and swelling in your leg or groin.
    • Your heartbeat feels very fast or slow, skips beats, or flutters.
    • You are dizzy or lightheaded, or you feel like you may faint.
    • You have new or increased shortness of breath.

    Watch closely for changes in your health, and be sure to contact your doctor if:

    • You gain weight suddenly, such as 3 pounds or more in 2 to 3 days.
    • You have increased swelling in your legs, ankles, or feet.
    • You have any concerns about your incision.
    • You feel very sad or have other signs of depression, such as trouble sleeping or eating.
    • You have questions about diet, exercise, quitting smoking, or stress reduction after surgery.
  • Self-Care

    How can you care for yourself after a heart transplant?

    Activity

    Continue the cardiac rehab program you started in the hospital. Your program has details about your activity level and your diet. Here are some general guidelines:

    • Rest when you feel tired. Getting enough sleep will help you recover. Try to sleep on your back for 8 to 12 weeks while your breastbone (sternum) heals. This usually takes at least 6 to 8 weeks.
    • Try to walk each day as directed by your cardiac rehab program. Start by walking a little more than you did the day before. Bit by bit, increase the amount you walk. Walking boosts blood flow and helps prevent pneumonia and constipation.
    • Avoid strenuous activities, such as bicycle riding, jogging, weight lifting, or heavy aerobic exercise, until your doctor says it is okay.
    • For 3 months, avoid activities that strain your chest or upper arm muscles. This includes pushing a lawn mower or vacuum, mopping floors, or swinging a golf club or tennis racquet.
    • For 2 to 3 months, avoid lifting anything that would make you strain. This may include heavy grocery bags and milk containers, a heavy briefcase or backpack, cat litter or dog food bags, or a child.
    • Ask your doctor when you can drive again.
    • You will probably need to take at least 6 weeks off from work. It depends on the type of work you do and how you feel.
    • Do not swim or use a hot tub until your doctor says it is okay.
    • Ask your doctor when it is okay for you to have sex.

    Diet

    • Eat a healthy diet. Your doctor can help you learn about healthy eating. You also may want to talk to a dietitian. A dietitian can help you learn about healthy foods.
    • Drink plenty of fluids (unless your doctor tells you not to).
    • You may notice that your bowel movements are not regular right after your surgery. This is common. Try to avoid constipation and straining with bowel movements. You may want to take a fiber supplement every day. If you have not had a bowel movement after a couple of days, ask your doctor about taking a mild laxative.

    Medicines

    • Your doctor will tell you if and when you can restart your medicines. He or she will also give you instructions about taking any new medicines.
    • If you take aspirin or some other blood thinner, ask your doctor if and when to start taking it again. Make sure that you understand exactly what your doctor wants you to do.
    • Your doctor will give you anti-rejection medicines. He or she may also give you medicines to prevent blood clots, keep your heartbeat steady, and lower your blood pressure and cholesterol. Take your medicines exactly as prescribed. Call your doctor if you think you are having a problem with your medicine.
    • Take pain medicines exactly as directed.
      • If the doctor gave you a prescription medicine for pain, take it as prescribed.
      • If you are not taking a prescription pain medicine, ask your doctor if you can take an over-the-counter medicine.
      • Do not take aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve), or other nonsteroidal anti-inflammatory drugs (NSAIDs) unless your doctor says it is okay.
    • If you think your pain medicine is making you sick to your stomach:
      • Take your medicine after meals (unless your doctor has told you not to).
      • Ask your doctor for a different pain medicine.
    • If your doctor prescribed antibiotics, take them as directed. Do not stop taking them just because you feel better. You need to take the full course of antibiotics.

    Incision care

    • If you have strips of tape on the cuts (incisions) the doctor made, leave the tape on for a week or until it falls off.
    • Wash the area daily with warm, soapy water, and pat it dry. Don’t use hydrogen peroxide or alcohol, which can slow healing. You may cover the area with a gauze bandage if it weeps or rubs against clothing. Change the bandage every day.
    • Keep the area clean and dry.

    Other instructions

    • Hold a pillow firmly over your chest incision when you cough or take deep breaths. This will support your chest and reduce your pain.
    • Do breathing exercises at home as instructed by your doctor. This will help prevent pneumonia.
    • You may shower as usual. Pat the incision dry. Do not take a bath for the first 3 weeks, or until your doctor tells you it is okay.
    • Do not smoke. Smoking can make it harder for you to recover. If you need help quitting, talk to your doctor about stop-smoking programs and medicines. These can increase your chances of quitting for good.
    • Check with your doctor before you drink alcohol. Alcohol can cause problems with some of the medicines used to prevent organ rejection.

    Copyrighted material adapted with permission from Healthwise, Incorporated. This information does not replace the advice of a doctor.