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Heart Transplant

Surgery Overview

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) immediately after surgery, and you must continue to take them.

What To Expect After Surgery

After a heart transplant, the recovery process is similar to the process after other heart surgeries.

You will spend about 1 to 2 weeks in the hospital after surgery. You may have to stay longer depending on your health and if you have complications from surgery. While in the hospital, you will start a cardiac rehabilitation program. And your doctors will check on your heart to make sure your body isn't rejecting it.

Cardiac rehabilitation

A cardiac rehab program can help you recover from your surgery and be active again.

Your transplanted heart will respond to activity a little differently. Your heart rate will not increase like it used to. And you will have a higher resting heart rate. This is because some of the nerves that control your heart were cut during your surgery.

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

Why It Is 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 his or her life expectancy.
  • The doctor strongly expects that a heart transplant will increase survival and improve the person's quality of life.

At some centres, 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.

How Well It Works

In carefully selected people, a heart transplant can be very successful. About 8 out of 10 people who have a heart transplant survive for at least 5 years.footnote 1

Most people can have a good quality of life after their transplant. They can be active, have a social life, and return to work.footnote 2

Risks

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 and also do echocardiography, electrocardiography (ECG, EKG), or blood tests.
    • If your body rejects the heart, you will receive additional 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 is an important limiting factor that affects long-term survival.)
  • Death.

What To Think About

Candidates receive a donor heart according to the:

  • Date they were placed on the waiting list.
  • Severity of their heart failure symptoms.

There are limited donor hearts available.

References

Citations

  1. Hart A, et al. (2017). OPTN/SRTR 2015 annual data report: Kidney. American Journal of Transplantation, 17(Suppl 1): 21-116. DOI: 10.1111/ajt.14124. Accessed April 26, 2017.
  2. Patel JK, Kobashigawa JA (2011). Heart transplantation. Circulation, 124(4): e132–e134.

Credits

Current as of:
August 31, 2020

Author: Healthwise Staff
Medical Review:
Rakesh K. Pai MD, FACC - Cardiology, Electrophysiology
E. Gregory Thompson MD - Internal Medicine
Kathleen Romito MD - Family Medicine
Martin J. Gabica MD - Family Medicine
Elizabeth T. Russo MD - Internal Medicine
Adam Husney MD - Family Medicine
Stephen Fort MD, MRCP, FRCPC - Interventional Cardiology