OverviewA heart transplant is an operation in which a failing heart is replaced with a healthier donor heart. Heart transplant is a treatment that's usually reserved for people whose condition hasn't improved enough with medications or other surgeries. Show
While a heart transplant is a major operation, your chance of survival is good with appropriate follow-up care. Why it's doneHeart transplants are performed when other treatments for heart problems haven't worked, leading to heart failure. In adults, heart failure can be caused by:
In children, heart failure is most often caused by either a congenital heart defect or cardiomyopathy. Another organ transplant may be performed at the same time as a heart transplant (multiorgan transplant) in people with certain conditions at select medical centers. Multiorgan transplants include:
A heart transplant is not right for everyone, however. You might not be a good candidate for a heart transplant if you:
Ventricular assist devicesFor some people who cannot have a heart transplant, another option may be a ventricular assist device (VAD). A VAD is a mechanical pump implanted in your chest that helps pump blood from the lower chambers of your heart (ventricles) to the rest of your body. VADs are commonly used as temporary treatments for people waiting for heart transplants. These devices are increasingly being used as long-term treatment for people who have heart failure but are not eligible for heart transplants. If a VAD doesn't help your heart, doctors may sometimes consider a total artificial heart — a device that replaces the ventricles of your heart — as an alternative short-term treatment while you're waiting for a heart transplant. RisksBesides the risks of having open-heart surgery, which include bleeding, infection and blood clots, risks of a heart transplant include:
How you preparePreparations for a heart transplant often begin weeks or months before you receive a donor heart. Taking the first stepsIf your doctor recommends a heart transplant, you'll likely be referred to a heart transplant center for evaluation. Or you can select a transplant center on your own. Check your health insurance to see which transplant centers are covered under your plan. When evaluating a heart transplant center, consider the number of heart transplants a center performs each year and the survival rates. You can compare transplant center statistics using a database maintained by the Scientific Registry of Transplant Recipients. You should also check to see if a transplant center offers other services you might need. These include coordinating support groups, assisting with travel arrangements, helping you find local housing for your recovery period or directing you to organizations that can help with these concerns. Once you decide on a center, you'll need to have an evaluation to see if you're eligible for a transplant. The evaluation will check to see if you:
Waiting for a donor organIf the transplant center medical team determines that you're a good candidate for a heart transplant, the center will put you on a waiting list. The wait can be long since there are more people who need hearts than donors. Finding a donor depends on your size, your blood type and how sick you are. While you're on the waiting list, your medical team will monitor your heart and other organs and adjust your treatment as necessary. The team will help you learn to care for your heart by eating well and being active. If medical therapy fails to support your vital organs as you wait for a donor heart, your doctors might recommend that you have a ventricular assist device (VAD) implanted to support your heart while you wait for a donor organ. The devices are also referred to as bridges to transplantation because they gain you some time to wait until a donor heart is available. Immediately before your transplant surgeryA heart transplant usually needs to occur within four hours of organ removal for the donor organ to remain usable. As a result, hearts are offered first to a transplant center close by and then to centers within certain distances of the donor hospital. The transplant center can provide you with a pager or cellphone to notify you when a potential heart is available. You must keep your cellphone or pager charged and turned on at all times. Once you're notified, you and your transplant team have limited time to accept the donation. You'll have to go to the transplant hospital immediately after being notified. As much as possible, make travel plans ahead of time. Some heart transplant centers provide private air transportation or other travel arrangements. Have a suitcase packed with everything you'll need for your hospital stay, as well as an extra 24-hour supply of your medications. Once you arrive at the hospital, your doctors and transplant team will conduct a final evaluation to determine if the donor heart is suitable for you and if you're ready for surgery. If your doctors and transplant team decide that either the donor heart or surgery isn't appropriate for you, you might not be able to have the transplant. Transporting donor organs for transplantMayo doctors and staff can receive donor organs from other locations and transport them to prepare them for transplantation. What you can expectDuring the procedureHeart transplant surgeryMayo Clinic cardiac surgeons work with a team to perform heart transplant surgery. Heart transplant surgery is an open-heart procedure that takes several hours. If you've had previous heart surgeries, the surgery is more complicated and will take longer. You'll receive medication that causes you to sleep (general anesthetic) before the procedure. Your surgeons will connect you to a heart-lung bypass machine to keep oxygen-rich blood flowing throughout your body. Your surgeon will make an incision in your chest. Your surgeon will separate your chest bone and open your rib cage so that he or she can operate on your heart. Your surgeon then removes the diseased heart and sews the donor heart into place. He or she then attaches the major blood vessels to the donor heart. The new heart often starts beating when blood flow is restored. Sometimes an electric shock is needed to make the donor heart beat properly. You'll be given medication to help with pain control after the surgery. You'll also have a ventilator to help you breathe and tubes in your chest to drain fluids from around your lungs and heart. After surgery, you'll also receive fluids and medications through intravenous (IV) tubes. After the procedureYou'll initially stay in the intensive care unit (ICU) for a few days, then be moved to a regular hospital room. You're likely to remain in the hospital for a week or two. The amount of time spent in the ICU and in the hospital varies from person to person. After you leave the hospital, your transplant team will monitor you. Due to the frequency and intensity of the monitoring, many people stay close to the transplant center for the first three months. Afterward, the follow-up visits are less frequent, and travel is easier. You'll also be monitored for any signs or symptoms of rejection, such as shortness of breath, fever, fatigue, not urinating as much or weight gain. It's important to let your transplant team know if you notice any signs or symptoms of rejection or infection. To determine whether your body is rejecting the new heart, you'll have frequent heart biopsies in the first few months after heart transplantation, when rejection is most likely to occur. The frequency of necessary biopsies decreases over time. During a heart biopsy, a doctor inserts a tube into a vein in your neck or groin and directs it to your heart. The doctor runs a biopsy device through the tube to remove a tiny sample of heart tissue, which is examined in a lab. You'll need to make several long-term adjustments after you have had your heart transplant. These include:
ResultsMost people who receive a heart transplant enjoy a good quality of life. Depending on your condition, you may be able to resume many of your daily life activities, such as work, hobbies and sports, and exercising. Discuss with your doctor what activities are appropriate for you. Some women who have had heart transplants can become pregnant. However, talk to your doctor if you're thinking about having children after your transplant. You'll likely need medication adjustments before becoming pregnant, as some medications can cause pregnancy complications. Survival rates after heart transplantation vary based on a number of factors. Survival rates continue to improve despite an increase in older and higher risk heart transplant recipients. Worldwide, the overall survival rate is about 90% after one year and about 80% after five years for adults. What if your new heart fails?Heart transplants aren't successful for everyone. Your new heart can fail for a number of reasons. Your doctor might then suggest adjusting your medications or, in more extreme cases, having another heart transplant. If additional treatment options are limited, you might choose to stop treatment. Discussions with your heart transplant team, doctor and family should address your expectations and preferences for treatment, emergency care and end-of-life care. Clinical trialsExplore Mayo Clinic studies of tests and procedures to help prevent, detect, treat or manage conditions. Coping and SupportIt's normal to feel anxious or overwhelmed while waiting for a transplant or to have fears about rejection, returning to work or other issues after a transplant. Seeking the support of friends and family members can help you cope during this stressful time.
Diet and nutritionAfter your heart transplant, you may need to adjust your diet to keep your heart healthy and functioning well. Maintaining a healthy weight through diet and exercise can help you avoid complications such as high blood pressure, heart disease and diabetes. A nutrition specialist (dietitian) can discuss your dietary needs and answer your questions after your transplant. You'll have several healthy food options and ideas to use in your eating plan. Your dietitian's recommendations may include:
You might also:
ExerciseAfter your transplant, your doctor may recommend that you make exercise and activity a regular part of your life to continue to improve your overall physical and mental health. Exercising regularly can help you control your blood pressure, reduce stress, maintain a healthy weight, strengthen your bones and increase your physical function. Your treatment team will create an exercise program designed to meet your individual needs and goals. You'll participate in cardiac rehabilitation to help improve your endurance, strength and energy. Cardiac rehabilitation helps you improve your health and recover after your heart transplant. Your exercise program may include warm-up exercises such as stretching or slow walking. Your treatment team may suggest walking, bicycling, strength training and other exercise. Specialists in the treatment team will likely suggest that you cool down after you exercise, perhaps by walking slowly. Discuss with your treatment team what may be appropriate for you. Take a break from exercising if you feel tired. If you feel symptoms such as shortness of breath, nausea, irregular heart rate or dizziness, stop exercising. If your symptoms don't go away, contact your doctor right away. What type of medication is prescribed for a patient who has undergone heart transplant surgery?After your transplant surgery you will be prescribed medications that may include: Tacrolimus (Prograf) or cyclosporine (Neoral, Gengraf) Prednisone. Mycophenolate (CellCept, Myfortic) or azathioprine (Imuran)
Which medication can be administered to control the heart rate of a patient diagnosed with obstructive hypertrophic cardiomyopathy?Medications to treat hypertrophic cardiomyopathy and its symptoms might include: Beta blockers such as metoprolol (Lopressor, Toprol-XL), propranolol (Inderal, Innopran XL) or atenolol (Tenormin) Calcium channel blockers such as verapamil (Verelan, Calan SR,) or diltiazem (Cardizem, Tiazac)
Which procedure will the nurse prepare the patient for if the surgeon is trying to rule out rejection of a new heart transplant?Heart transplant.
In heart transplant, a right-heart catheterization helps measure the function of the transplanted heart and allows a doctor to take a biopsy to make sure the transplanted heart is not being rejected.
Which negative inotropic agent can be administered to a patient with obstructive hypertrophic cardiomyopathy?The negative inotropic and type I-A antiarrhythmic drug disopyramide (in combination with a β blocker) has been introduced into the treatment regimen of patients with obstructive HCM who are refractory to β blockers and verapamil, and has been shown to reduce heart failure symptoms and outflow gradient without ...
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