Understanding Heart Transplantation

Heart transplantation is one of the most successful advances in modern medicine. A fascinating aspect is that heart transplantation is the product of research, surgical technique, and medical forethought that have come together to allow its occurrence as a regular procedure saving countless lives.

The Basics of Heart Transplantation

Heart transplantation is the replacement of a failing heart with a healthy heart from a suitable donor. It is an operation usually reserved for people with a poor condition of their heart which hasn’t improved with medications or other therapies.

The number of people in need of heart transplantation far exceeds the number of available donor organs. Because of that, there is a waitlist for receiving a donor heart, and a multidisciplinary team of healthcare providers put a patient on this waiting list only after determining that a transplant would be the best course of action. Patients should undergo a rigorous assessment and be cleared for transplantation as those in poor overall health might not be able to survive the operation and post-operative period.

Reasons for Heart Transplantation

Heart disease is the leading cause of death worldwide and heart transplantation might be needed for various reasons. The most common reason is severe heart failure, a condition in which the heart fails to pump blood effectively through the body. If severe heart failure is diagnosed and other therapies are exhausted, then the patient might be put on a transplant waiting list in the hopes of receiving a heart transplantation before  the underlying condition leads to death. Other reasons are heart problems people are born with (congenital heart disease), or dangerous recurrent abnormal heart rhythms (arrhythmias) not controlled by other treatments.

Outcomes and Risks of Heart Transplantation

Survival and functional status after heart transplantation are generally excellent. Patients are usually able to return to work, regardless of their profession. The 1-year survival is almost 90%, and the mean survival for donor heart recipients is 13 years.

As with any type of surgery, however, there are certain risks which include the following:

• Bleeding
• Infection
• Breathing problems
• Kidney failure
• Rejection of the donor heart
• Death

Patients are closely and regularly monitored following heart transplantation as there is the risk that the recipient’s body rejects the donor heart. The immune system is set up to see any foreign object as a threat and attack it and this also the case with a donor organ which comes from another person. Anti-rejection medications have revolutionized the field of heart transplantation and currently available prescription medications provide a good chance that the donor organ will be accepted. There are side effects to these medications, however, including the following:

• Infections that might occasionally be severe
• Cancer
• Kidney failure

Non-compliance with the recommended medication and monitoring plan will increase the chance that the donor heart is rejected. As such, patients undergoing heart transplantation should closely follow their doctors’ orders.

How a Heart Transplant is Performed

The first step to heart transplantation is the identification of a suitable donor heart. After that, the donor organ is procured and transported to the recipient’s hospital where the heart transplant will take place. The surgery is an open-heart procedure that takes several hours.

First, medications that put the patient to sleep (anesthesia) are given. Then the chest wall is cleaned and possibly shaved, and the surgeon makes an incision in the chest.

The chest bone is cut and separated, and the rib cage is opened so that the surgeon can operate on the heart. Tubes are put into the chest vessels to pump oxygen-rich blood through the body (heart-lung bypass machine) while the transplant is being performed. The diseased heart is removed and the donor’s heart is sewed into place. Then, the surgeon will attach the major blood vessels to the donor heart and ensure there is no leakage.

The donor heart often starts beating once blood flow is restored. Sometimes the donor heart is given an electrical shock make it beat properly. Then, the team will watch the donor heart closely to ensure that it is working properly. Finally, the surgeon will rejoin the chest bone with small wires and sew the skin back together. Tubes will be inserted in the chest to drain blood and fluids and a sterile bandage will remain in place until the wound is fully healed. Medications are given to help with pain control, and a ventilator is used to help with breathing. Fluids and medications are given via intravenous tubes.

The patient usually stays for a few days in the intensive care unit (ICU) and is then moved to a regular hospital room. Most times, patients remain in the hospital for a week or two, but the time spent in the ICU and in the hospital in general can vary.

Conclusion

Heart transplantation is a successful treatment option for patients suffering severe heart disease. It has been made possible after years of experimentation in the lab and bedside, and has become a standard, first line therapy option saving the lives of countless people. What is certain, is that more innovations and advances lie ahead to make this therapy even more successful and applicable to more and more patients. Heart transplants will continue to get better and more successful with further advances in cardiovascular research.

Next Frontier – CVRTI Research

CVRTI Investigators are not just performing heart transplants[TH1]  and taking care of patients[TH2]  before and after they receive their transplant, but are advancing science[TH3]  to also recover failing hearts[TH4] , understand the science of what makes hearts fail (Chaudhuri, Drakos, Dosdall, Franklin, Hoareau, Hong, Palatinus, Ranjan, Shaw)[TH5] , and developing novel gene therapies to treat patients with heart failure (Dosdall, Hoareau, Hong, Palatinus, Shaw)[TH6] .  Each heart transplant is a medical miracle yet CVRTI Investigators are advancing the field towards an ultimate goal of patients never needing a replacement heart to survive.

Resources:

Alraies MC, Eckman P. Adult heart transplant: indications and outcomes. J Thorac Dis. 2014 Aug;6(8):1120-8. doi: 10.3978/j.issn.2072-1439.2014.06.44. PMID: 25132979