What Do You Know About Life Saving Heart Transplants?

The history of medical innovations is highlighted by countless life-saving milestones. One medical high point was the first heart transplant in December 1967.

Physicians at Aurora St. Luke’s Medical Center performed the first heart transplant in the Midwest about 10 months later (Oct 1968). The recipient was a middle-aged housewife from West Allis who was suffering with terminal heart failure. She lived 8-1/2 years after the transplant and was longest living heart transplant survivor at the time.

Since those pioneering procedures, heart transplant techniques and survival rates have continued to improve.

What Does a Heart Transplant Involve?

The name of this procedure is pretty straightforward — a highly trained surgical team removes a severely damaged or diseased heart from a patient and replaces it with a healthy heart from donor.

Most heart transplant recipients have end-stage heart failure, severe coronary artery disease, congenital (from birth) disease or life-threatening heart rhythms. The heart transplant is the last resort for patients who have not had success with any other treatments.

Heart Transplant Selection Process

Heart transplant recipients go through an extensive selection process. They need to have a heart condition severe enough that only a transplant will save their life, and they need to be healthy enough to survive the serious surgery.

A number of tests will be conducted to determine if the patient is a good fit for a transplant. The tests include medical, surgical and psychosocial evaluations to find out if the patient is physically and mentally equipped to cope with the transplant process and possible outcomes. The surgery and recovery have significant long-term risks such as infection and organ rejection.

The patient may also suffer from side effects of drugs that are required to suppress the immune system and reduce the chances for rejection. These drugs will need to be taken for the rest of the heart transplant recipient’s life.

The Transplant Decision

The results of the tests will go to a selection committee that will discuss if the heart transplant is the best option for the patient. If so, the patient will be registered with a national system called United Network for Organ Sharing (UNOS), which has created rules that help match transplant recipients with available organs.

Patients go on a national waiting list for a donor heart. The wait can last days or years depending on when a good match becomes available.

It’s estimated that 50,000 people may be eligible for heart transplantation, roughly 15,000 are evaluated in the US and only 2500 are transplanted annually.

The Transplant Procedure

When patients in the transplant program are matched with an available heart, they’ll be called to the transplant hospital for the surgery. There is a real sense of urgency to complete the surgery since donor hearts typically remain viable for less than six hours outside of the body. That means within six hours of removal of a heart (which may occur in another hospital several hours away), the organ must be surgically implanted and re-animated.

Once in the operating room:

  • The patient will be put to sleep under general anesthesia.
  • The patient will receive an IV to receive medications and a breathing tube will be passed through the throat to provide oxygen. A catheter is also inserted to empty the bladder.
  • The surgeon will make an incision along the breastbone to open the rib cage and access the heart. The patient is connected to a heart-lung bypass machine that temporarily takes over the work of the heart and lungs during the surgery.
  • The surgical team stops the damaged heart, removes it and replaces it with the donor heart.
  • Once all the heart’s blood vessels are reconnected surgically, the team restarts the donor heart using electrical shock (defibrillation) or medications. Once a healthy heartbeat has been established, the team closes the incision. A draining tube is left in the chest cavity to drain blood and fluid. The surgery usually takes four to six hours.

Transplant Recovery

After the surgery, a ventilator helps the patient breathe. The chest drainage tubes, monitoring catheters and breathing tube remain in place for only 1-2 days. Generally, patients are taking their first few bites of food and starting to participate in therapy over that same time frame.

The patient will also start taking immunosuppression or anti-rejection medications. The medical team explains to the patient how to take these medications and do self-care at home. Physical therapy is also part of the recovery process. At Aurora St. Luke’s, most patients are discharged and go home within 10 days.

After discharge, regular follow-up visits to the hospital for biopsy, blood work, clinic and rehabilitation is performed to optimize recovery and keep track of progress. Medications may be fine-tuned by the medical team.

Within a few months most heart transplant recipients feel strong enough to return to work and their normal daily activities.

Heart transplant surgery can extend the lives of individuals suffering from congestive heart failure, severe coronary artery disease or a heart defect that medications can’t remedy.

If you have questions about your heart health, visit with your health care professional. Patients with heart problems will be referred to a cardiovascular specialist.

It’s good for you and your overall health to learn ways you can improve your heart health. It’s never too late to start!

Meet the Author

Vinay Thohan, MD is a cardiologist at Aurora St. Luke's Medical Center In Milwaukee, WI.

Read more posts from this author

The information presented in this site is intended for general information and educational purposes. It is not intended to replace the advice of your own physician. Contact your physician if you believe you have a health problem.

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