About heart transplant

What is heart transplant?

Introduction to heart transplant

The idea of replacing a bad organ with a good one has been documented in ancient mythology. The first real organ transplants were probably skin grafts that may have been done in India as early as the second century B.C. The first heart transplant in any animal is credited to Vladimer Demikhov. Working in Moscow in 1946, Demikhov switched the hearts between two dogs. The dogs survived the surgery. The first heart transplant in human beings was done in South Africa in 1967 by Dr. Christiaan Barnard; the patient only lived 18 days. Most of the research that led to successful heart transplantation took place in the United States at Stanford University under the leadership of Dr. Norman Shumway. Once Stanford started reporting better results, other centers started doing heart transplants. However, successful transplantation of a human heart was not ready for widespread clinical application until medications were developed to prevent the recipient from "rejecting" the donor heart. This happened in 1983 when the Food and Drug Administration (FDA) approved a drug called cyclosporine (Gengraf, Neoral). Before the advent of cyclosporine, overall results of heart transplant were not very good.

Learn more about: Neoral

Learn more about: Neoral

What is a heart transplant?

Believe it or not, heart transplantation is a relatively simple operation for a cardiac surgeon. In fact, the procedure actually consists of three operations.

The first operation is harvesting the heart from the donor. The donor is usually an unfortunate person who has suffered irreversible brain injury, called "brain death". Very often these are patients who have had major trauma to the head, for example, in an automobile accident. The victim's organs, other than the brain, are working well with the help of medications and other "life support" that may include a respirator or other devices. A team of physicians, nurses, and technicians goes to the hospital of the donor to remove donated organs once brain death of the donor has been determined. The removed organs are transported on ice to keep them alive until they can be implanted. For the heart, this is optimally less than six hours. So, the organs are often flown by airplane or helicopter to the recipient's hospital.

The second operation is removing the recipient's damaged heart. Removing the damaged heart may be very easy or very difficult, depending on whether the recipient has had previous heart surgery (as is often the case). If there has been previous surgery, cutting through the scar tissue may prolong and complicate removal of the heart.

The third operation is probably the easiest; the implantation of the donor heart. Today, this operation basically involves the creation of only five lines of stitches, or "anastomoses". These suture lines connect the large blood vessels entering and leaving the heart. Remarkably, if there are no complications, most patients who have had a heart transplant are home about one week after the surgery. The generosity of donors and their families makes organ transplant possible.

Picture of the Heart and Great Vessels in Heart Transplant Picture of the Heart in the Pericardial Sac Picture of the Interior of the Heart in the Paricardial Sac



What are the treatments for heart transplant?

People who need a heart transplant are typically those whose conditions haven't improved enough with medication or other procedures.

Heart transplant treatment

  • Your doctor might suggest particular procedures or surgery if drugs are insufficient for your heart problems. Open-heart surgery for heart transplants lasts for several hours. If you've had previous cardiac operations, the procedure will be more difficult and take longer.
  • Before the procedure, you'll be given a general anesthetic—a drug that puts you to sleep. To keep oxygen-rich blood flowing throughout your body, your surgeons will attach you to a heart-lung bypass machine.
  • Your chest will be cut open by the surgeon. To perform a cardiac operation, your surgeon will split your chest bone and crack apart your rib cage.
  • The damaged heart is subsequently removed by your surgeon, who then sews the donor heart into place. The major blood vessels are then joined to the donor's heart by the surgeon. Once blood flow has been reestablished, the new heart frequently begins to beat. To get the donor heart to beat properly, an electric shock may occasionally be necessary.
  • After the procedure, you will be given medicine to assist you in managing your pain. Additionally, you'll have tubes in your chest to drain fluid from the area around your heart and lungs, as well as a ventilator to assist with breathing. You will also be given fluids and drugs via intravenous (IV) tubes following surgery.



What are the risk factors for heart transplant?

Besides the risks of having open-heart surgery, which include bleeding, infection and blood clots, risks of a heart transplant include:

  • Rejection of the donor heart. One of the most worrying risks after a heart transplant is your body rejecting the donor heart.

    Your immune system may see your donor heart as a foreign object and try to reject it, which can damage the heart. Every heart transplant recipient receives medications to prevent rejection (immunosuppressants), and as a result, the rate of organ rejection continues to decrease. Sometimes, a change in medications will halt rejection if it occurs.

    To help prevent rejection, it's critical that you always take your medications as prescribed and keep all your appointments with your doctor.

    Rejection often occurs without symptoms. To determine whether your body is rejecting the new heart, you'll have frequent heart biopsies during the first year after your transplant. After that, you won't need biopsies as often.

  • Primary graft failure. With this condition, the most frequent cause of death in the first few months after transplant, the donor heart doesn't function.
  • Problems with your arteries. After your transplant, it's possible that the walls of the arteries in your heart could thicken and harden, leading to cardiac allograft vasculopathy. This can make blood circulation through your heart difficult and can cause a heart attack, heart failure, heart arrhythmias or sudden cardiac death.
  • Medication side effects. The immunosuppressants you'll need to take for the rest of your life can cause serious kidney damage and other problems.
  • Cancer. Immunosuppressants can also increase your risk of developing cancer. Taking these medications can put you at a greater risk of skin cancer and non-Hodgkin's lymphoma, among others.
  • Infection. Immunosuppressants decrease your ability to fight infection. Many people who have heart transplants have an infection that requires them to be admitted to the hospital in the first year after their transplant.



Is there a cure/medications for heart transplant?

Certain cures and meditation can help to improve — or even prevent — heart transplants. The following cure/meditation can help anyone who wants to improve heart health:

  • Request a blood pressure check from your doctor at least every two years. If your blood pressure is greater than usual or you have a history of heart disease, he or she could suggest taking readings more frequently. The ideal blood pressure in millimetres of mercury is less than 120 systolic and 80 diastolic (mm Hg)
  • The risk of heart disease can be decreased if you have diabetes by maintaining strict blood sugar control.
  • Exercise aids in achieving and maintaining a healthy weight as well as managing heart disease risk factors like diabetes, high cholesterol, and blood pressure. Speak to your doctor about any potential constraints on your ability to participate in certain activities if you have a cardiac arrhythmia or heart defect. Aim for 30 to 60 minutes of physical activity on most days of the week with your doctor's approval



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