Heart (Cardiac) Transplant

 Heart (Cardiac) Transplant

Operation goal:

Heart transplantation aims to provide the patient with a healthy heart, due to the loss of his heart's ability to function properly, due to many causes and factors that ultimately lead to terminal heart failure (end-stage cardiac disease):

Acute or chronic heart failure, after an ischemic heart disease, damage to the heart sections, heart injury due to diabetes, cardiomyopathy, chronic lung disease that leads to heart failure, heart damage after injury With an infectious disease, congenital heart defects and others. Final heart failure that calls for a heart transplant is a disease in which the condition is not expected to improve by using pharmacological or other surgical treatment methods, and where the maximum life expectancy, in the absence of a heart transplant, is from one to two years.

During a heart transplant, the patient’s body is supported by a heart-lung machine, which acts as an external pump for the patient’s blood, in order to oxidize the blood and eliminate toxins, while the new heart is implanted into the patient’s chest.

The heart is donated by a donor who died recently, not for cardiac reasons, which means that the transplanted heart is healthy. We often talk about donors who have suffered brain death. Despite trying to raise public awareness regarding the issue of organ donation, we still suffer from a severe shortage of organ donors.

Preparing for the operation:

There is no need to perform a tissue conformity test or blood type test when performing a heart transplant, as there are today excellent treatments that are given to the patient after the operation, these drugs allow the body to accept the transplanted organ with high success rates.

In cases where these treatments are not available, a donor with HLA tissue and ABO blood type matching is needed.

Tests that the recipient must perform, include blood tests of the type: complete blood count (CBC), blood chemistry, blood clotting functions, kidney and liver function, urine examination, chest X-ray, a comprehensive dental examination (not to rule out a source of infection), and sometimes it is done Pre-performed cardiac catheterization (to ensure the integrity of the blood vessels and pressure in the pulmonary vessels).

Heart transplantation is performed under general anesthesia. The doctor should be consulted about the medicines that the patient must stop taking in the days before the operation, and the patient should fast completely for 8 hours before the operation.

Course of operation:

After a thorough chest sterilization procedure, a long central incision is made along the sternum, in the chest. Then, the bone is separated in order to gain access to all parts of the chest.

In the second stage, the work of the patient's heart and lungs is replaced by an artificial cardiopulmonary device, in order to maintain a healthy blood circulation during the operation, which is not through the chest (so that the surgeons can work in a clear and clean surgical site).

Heart and circulatory system, how do they work?

Cardiopulmonarybypass is performed by blocking the flow of blood in the main blood vessels (aorta, lung veins, etc.), and converting it to a machine, in order to supply oxygen and purify the blood from toxic substances, for a short period of time.

When the donated heart is ready, the surgeon opens the pericardium (the outer membrane of the heart) and removes the entire diseased heart except for the upper back part of the heart - that is, one of the atria in the heart, which is kept in the chest in order to connect it to the new heart.

The patient's large blood vessels and the healthy heart are sutured (by the large blood vessels in the healthy heart).

In the end, the patient's blood is directed back from the machine to the body. The cardiac membrane is closed and the chest sutured again. A drainage tube or several tubes are placed in the chest in order to drain the remaining fluid and blood in the tissues. A large dressing is placed over the incision.

  Operation Risks:

General risks of surgeries:

Infection in a surgical incision - it is often superficial and is treated locally, but sometimes more serious infection can occur in the tissues under the skin and even in the breastbone, which requires the incision to be opened again in order to remove the bacterial remnants.

Bleeding - especially in the surgical area as a result of localized tissue trauma. Bleeding can occur immediately after the operation, and even 24 hours after the operation. In very rare cases, bleeding may appear after several weeks or even months after. Bleeding occurs as a result of rupture and bleeding from small or large blood vessels, or as a result of improper connection between the blood vessels.

In cases where significant bleeding occurs, additional drainage is required. When significant bleeding occurs, causing large amounts of blood to be lost. Additional surgery may be required to stop the bleeding from the blood vessel.

Scars - The nature of scars healing depends on the efficacy of the sutures and genetic factors. There is no way to predict how scars will heal after surgery.

Risks of anesthesia - there is often talk about phenomena related to hypersensitivity to anesthetic drugs (allergic response). In some rare cases, a very low blood pressure (anaphylactic shock) may occur.

Special risks:

Damage to the large blood vessels of the heart - due to the use of sharp equipment.

The heart's structure has been damaged - the valves, muscle or membrane.

Acute rejection of the transplanted heart - This is a severe immune reaction of the body against the transplanted heart, if it occurs within 60 days of the transplant. Several medications are given to avoid this rejection.

Postoperative treatment:

After the transplant is completed, the patient stays in the intensive care unit, under medical supervision, for resuscitation, for 1-3 days. After that, he stays in the department for an additional 10-14 days.

Sometimes an external pacemaker is implanted during surgery, this new device helps the heart perform its electrical function in the first days, until the heartbeat is regular.

Drugs that suppress the immune system are given immediately, in order to avoid the occurrence of rejection by the body of the transplanted heart, as much as possible. These drugs are taken for a long time, and sometimes for the whole of life, and they require careful monitoring of blood tests and kidney function in the patient, due to their various side effects.

In addition, antibiotics are taken to prevent infection, and the patient is provided with fluids to maintain blood pressure after the transplant.

Pain relievers are given intravenously, as needed.

The dressing and stitches are removed from the incision after one to two weeks after the heart transplant. The drained tubes are taken out as needed and according to the amount of fluid and bleeding drained.

In cases where a sudden increase in body temperature appears, hypotension, shortness of breath, urinary retention, heavy bleeding or intolerable pain, the doctor must be informed of this.

The process of recovery and return to daily activities after a heart transplant takes time, as it occurs slowly and gradually.