Heart Transplant Surgery: Meaning, Treatment, & Types Of Cardiac Transplant Surgery

Overview

Replacing a dysfunctional heart with a functional one from a donor is possible with heart transplant surgery . When other procedures have not worked, doctors typically suggest heart transplant surgery as a last resort for managing heart issues.

Before a heart transplant surgery, your doctor or medical team will determine whether your condition can only be treated through this option. Then only will your name be placed in the waiting list. Your doctor will also ensure whether your health otherwise is good enough for you to undergo this operation.

Even though heart transplant surgery is a big procedure, your likelihood of recovering is strong with the right management.
The heart transplant surgery cost varies according to the cities, hospitals and other medical issues associated with a heart transplant. Heart transplant surgery cost in India is 15—25 lakhs INR.

Reasons for a heart transplant surgery

When a patient’s heart failure has advanced to the point that no other treatment is working, a heart transplant surgery is their only option. As a result, the heart is unable to supply sufficient blood to the entire body because of an ongoing injury or dysfunction.
There are numerous causes of heart failure. The following conditions are present in the majority of those who require heart transplant surgery:

• Valvular heart disease occurs when one or two of the heart’s valves do not function properly and hamper the organ’s ability to pump blood through the body.
• Coronary artery disease (CAD) impacts the coronary arteries—the blood vessels, which supply blood to the heart. The coronary arteries may become partially clogged or gradually narrowed as a result of CAD. A person with CAD may have cardiac arrests or other effects, such as arrhythmia.
• Cardiomyopathy refers to heart muscle problems. Cardiomyopathy limits the heart’s capability to effectively circulate blood to the body’s tissues. As a result, one can feel exhausted, out of breath, or experience heart palpitations. With time, cardiomyopathy can worsen. Life expectancy can be enhanced by heart transplant surgery.
• Congenital Heart Disease (CHD) is a structural flaw in the heart that exists from birth.. It can be found at any moment during life, including before birth and shortly after. A CHD patient should visit a cardiologist frequently throughout their lifetime.

What are the preparations required for a heart transplant surgery?

A heart transplant is not a suitable treatment option for everybody. A transplant team will examine the patient because so many different details are required to determine whether a person is an acceptable candidate for a heart transplant.

A transplant surgeon, a transplant cardiologist (a physician with expertise in treating the heart), registered nurses, one or maybe more transplant nurses, a social worker, and a psychiatrist make up the transplant team. Dietitians, healthcare administrators, and anaesthetists are additional team members.

The transplant assessment procedure will involve:

• Blood tests to identify good donor compatibility and increase the likelihood that the donor’s heart won’t be rejected, blood tests are required.
• Social and psychological assessment to know whether there are any stressors like , money problems, and whether there is support from loved ones when it comes to the transplant operation. These factors can significantly impact whether one has the mental bandwidth to undergo such a major procedure, and how they will recover after the transplant.
• Diagnostic tests evaluate both the general health and condition of one’s lungs. X-rays, ultrasonography treatments, CT scans, pulmonary function tests (PFTs), and oral examinations are few such tests. Women may undergo mammography, gynaecological examination, and a pap test.
• Other preparations include getting vaccinated to lower the likelihood of contracting infections that can harm the donated heart.

While determining if you are qualified for heart transplant surgery, the surgical team will take all details into account. These details will be obtained through interviews, one’s medical history, as well as the results of the physical examination and diagnostic tests. The patient’s (recipient) name will be entered on the waiting list for a heart transplant after patient evaluation is complete and it is determined that the patient is medically eligible and prepared for the transplant procedure. The paperwork required for this transplant will then be filled out and signed by the patient. The patient needs to undergo routine testing and get reviewed by a transplant team. When a suitable donor heart becomes available, the patient is informed right away and admitted to the hospital. Since most hearts must be surgically transplanted within 4 hours of being extracted from the donor, the patient has to travel to the hospital at earliest possible for heart transplant surgery. Thus, it is advisable for the patient to remain within the proximity of their selected hospital in case a heart becomes available abruptly.

Before the transplant, these requirements need to be met:

• You can ask questions as the medical expert walks you through the procedure.
• To authorise the procedure, patients will be requested to provide their signature on a consent document. Carefully read the paperwork, and if anything is confusing, patients can ask questions.
• Once patients have been informed that a heart is now available, they shouldn’t consume any food or liquids (fast).
• To relax patients might be given medication (sedatives).
• The healthcare professional could ask patients to make other specific preparations based on their health condition.

Procedure for selecting a donor for heart transplant surgery

• When the patient is confirmed to be a candidate for a heart transplant, he will first be added to a standby list. Since there are currently not many hearts available, thousands of individuals are on the standby list for heart transplants.
• Doctors will keep an eye on the patient’s health as they wait for a healthy donor heart to become available. Depending on the patient’s health, the course of therapy may alter as they wait for a heart to become available for transplant.
• Some patients experience serious medical problems that may cause them to no longer qualify for heart transplant surgery. In this scenario, their name will be taken off the list until they are healthy again. They can be placed back on the standby list for a donor’s heart, depending on how well they heal.
• The doctors may suggest cardiac rehabilitation while they wait since it will teach them how to be healthy both before and following a heart transplant procedure.
• Sometimes patients’ health can degrade while they are waiting for a donor’s heart. This might be the case because the treatment option they are receiving cannot sustain their key organs. Health problems may result from this.
• Patients might require an implanting device like the ventricular assist unit in such a situation. This aids in keeping patients steady until a donor’s heart is available that can be implanted instead of the damaged one.
• When a donor’s heart is made available, several factors influence if it’s a suitable option or not. These variables include the amount of time patients have to wait for a heart donor and the priority of their request based on their health and blood group.
• A patient’s heart transplant surgery can only begin once the donor’s heart matches the recipient’s requirements.

Procedure for heart transplant surgery

• The process of heart transplant surgery is complicated. The procedure, which is an open surgery, takes a couple of hours. The heart transplant surgery may take more time than planned if this is a second operation on the heart.
• The patient will be put to sleep after administering general anaesthesia.
• The patient will be attached to a heart-lung bypass unit because the body needs to get blood that is rich in oxygen.
• The surgeon will create an opening (incision) that will allow them to perform Heart Transplant Surgery. The rib cage will be exposed and the chest bone (sternum) will be separated during the incision. The damaged heart will then be removed.
• The coronary arteries will then be connected to the donor heart when it is stitched into position. Blood flow can resume because of this process, so the new heart will begin to pump normally.
• The heart may receive an electric shock if it has trouble functioning.
• After the heart transplant operation is over, patients will be given painkillers.
• They will be placed on a ventilator machine so that they don’t experience breathing difficulties after heart transplant surgery.
• Following surgery, liquids need to be removed, which is accomplished with the aid of tubes connected to the lungs and heart.
• After the procedure, the patient will start receiving medications and liquids through IV lines.
• After the heart transplant surgery, the patient will remain in the Intensive Care Unit (ICU) for a few weeks.

Steps to be taken after the heart transplant surgery procedure
At the hospital:

• Following the procedure, someone from the transplant team will transport the patient to the ICU or rehabilitation area and keep a close eye on the patient for a few days.
• The electrocardiogram (ECG) trace, cardiac output, respiratory rate, and oxygen concentration will all be shown on devices that a caregiver will attach to the patient.
• A 7–14 day or longer stay in the hospital is necessary after heart transplant surgery.
• Unless the patient is capable of inhaling and exhaling on their own , a tube that links to a ventilator will pass through the patient’s throat. Depending on the circumstances, the breathing tube might be left inside for a few hours or perhaps a few days.
• The breathing apparatus will be modified so that the patient can take more control of their breathing as they recuperate. The doctor will take out the breathing tube after the patient can cough and breathe entirely on their  own.
• A transplant team member will assist the patient with coughing and breathing deeply every two hours just after the breathing tube has been removed.
• Because of the pain, it will be uncomfortable, but the patient must do it to prevent phlegm from building up in the lungs and potentially leading to pneumonia. The nurse will demonstrate how to cough comfortably while holding a pillow next to the chest.
• A tiny, plastic tube (catheter) may be inserted into the nose and even into the stomach to help patients expel the air they  swallow. When the bowels are functioning normally, the catheter will be removed. The patient won’t be capable of eating or drinking anything until the tube is taken out.
• Patients will get frequent blood checks to evaluate the health of their new heart and other body processes, including the vascular system, kidneys, liver, and lungs.
• Patients will be transferred from the intensive care unit (ICU) to a private ward when their healthcare professional believes they are fit. There, the healing process will continue. When the stomach and breathing lines are removed and the patient is stabilised, they may begin to drink liquids.
• Patients will be assisted while they start physiotherapy and breathing techniques by nurses, respiratory therapists, and physiotherapists.
• With the help of other experts like nurses, pharmacists, nutritionists, physiotherapists, and other transplant staff members, patients will learn how to care for themselves at home.
• In addition to setting up a follow-up appointment with the healthcare practitioner, the medical team will plan for the patient to return home.
  At home:
• It will be crucial to keep the surgery area dry and clean after getting home. Patients will receive particular bathing instructions from their doctor. If the stitches were not taken out before patients left the hospital, the doctor will remove them at a future appointment.
• Drive only after receiving permission from the healthcare provider. Additional activity limitations can be applied.
• After the transplant, patients will require numerous follow-up appointments. These visits could involve a biopsy, chest X-rays, and blood testing. During a biopsy, the doctor takes a small sample of heart tissue so they may study it under a microscope.
• The medical team will discuss the hospital visit and test schedule in detail. The rehabilitation treatment will last for several months.
• If patients experience include either a fever or shivers; the incision area, as well as any catheter areas being red, swollen, bleeding, or draining; increased discomfort near the site of the incision; difficulty breathing; excessive tiredness; and reduced blood pressure, immediate medical help is necessary
• Patients will require lifelong medication to prevent rejection so that the transplanted heart can function in the body. Drug reactions vary from person to person, and adverse effects can be severe. To match the needs, the healthcare professional will design the treatment plan.
• Initially, patients can receive numerous anti-rejection medications. Depending on the reaction, the doses of such medications may alter frequently.
• Infections are likely because patients will be prescribed anti-rejection medications that tend to suppress the immune system. It’s critical to find the right balance between making patients more susceptible to infection and minimising rejection.
• Oral yeast infections (thrush), herpes, and respiratory pathogens are a few of the illnesses to which patients will be most sensitive. For the first several months following the surgery, patients should keep their distance from large groups of people and anyone who appears to be sick.
• Patients will be called in for periodic right cardiac biopsies to check for any indications of rejection. In the initial weeks following a transplant, a biopsy is normally performed once weekly. Subsequently, monthly or longer periods are gradually included. The biopsy procedures might end in the future.
• If the patient is already in the hospital, the right heart biopsy technique can be completed as an inpatient treatment or as an outpatient treatment if the patient is not in the hospital.
• During the surgery, the right heart is catheterised. A special catheter is inserted inside the right atrium of the heart through a vein in either neck or groin.
• Four to six microscopic tissue samples are collected through the catheter by the doctor, who examines them for indications of rejection. The doctor might change the dosage of the anti-rejection medication if they discover evidence of rejection.

Life after a cardiac transplant

• After a heart transplant, patients will be under regular observation. Several tests will be carried out within the initial few months to make sure the body has accepted the new heart as well as to make sure no further issues arise. After a heart transplant, patients must constantly monitor their health if they want to maintain a high quality of life. Make sure they visit the doctor frequently and let him know about any issues they are having.
• Heart transplant surgery patients must pay attention to their diet and nutrition. To maintain heart health, one must take care of the body and make good decisions every day.
• One should always hydrate by consuming plenty of water.
• Make sure to eat plenty, and a wide range of fruits and vegetables every day.
• The doctor will address healthy eating practices with the patient in the context of their existing lifestyle so that the patient and doctor may both develop a meal pattern.
• If the patient is overweight or obese, they should think about using exercise and diet to help them lose weight. This will make it possible for them to live a long, healthy life.