Heart Transplantation

What to Expect

What to Do the Night Before

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Diagnostic Tests Before the Procedure

Several procedures or tests are usually completed at some point prior to a heart transplant. These tests may include, but are not limited to, the following:

• electrocardiogram (ECG or EKG) - a test that records the electrical activity of the heart, shows abnormal rhythms (arrhythmias or dysrhythmias), and detects heart muscle damage.
  
  
• blood work, which may include, but is not limited to:
  
  
  • blood count
    
    
  • cardiac isoenzymes (to check for damage to the heart muscle)
    
    
  • electrolytes (such as potassium, calcium, and sodium)
    
    
  • bleeding studies (to assess the blood-clotting process)
    
    
  • kidney function tests
    
    
  • blood and tissue typing
    
    
• chest x-ray - a diagnostic test that uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
  
  
• myocardial perfusion study - a type of nuclear scan that uses very small amounts of radioactive materials (radiopharmaceuticals) to assess the heart's function and structure; two common studies are radionuclide angiography and myocardial perfusion scan.
  
  
• echocardiography - a noninvasive (the skin is not pierced) procedure that assesses the heart's function and structures with ultrasonic sound waves.

If you have any type of breathing problems or lung condition, you may have pulmonary function tests done before the procedure to determine how well your lungs will tolerate the surgery.

Scheduling/Registration Information

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Where the Procedure is Done

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Who Performs the Procedure

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Directions to the Hospital

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It is important to arrive at your scheduled time. Your procedure may not begin immediately due to varying lengths of procedures scheduled before your procedure. You will be updated as frequently as possible.

Preparing for the Procedure in the Hospital

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• Description of IV, site preparations, and medications that may be administered - An intravenous (IV) line will be started in your hand or arm prior to the procedure for injection of medication and to administer IV fluids, if needed. Your skin will be scrubbed with a special soap in preparation for surgery. You will be given a hospital gown to wear. You will need to remove your dentures, glasses, and any prosthetic devices such as hearing aids, contact lenses, or artificial limbs. In addition, you will need to remove all jewelry and either give the items to a family member for safekeeping or have your nurse put it in the hospital's designated place, such as a safe. You will receive a sedative medication in your IV before the procedure to help you relax.
  
  
• Consent forms - You will be asked to sign a consent form after your physician explains the procedure, expected results, and possible complications and risks. Please read through the form carefully. If you have questions about anything in the consent form, please ask your physician to explain the information to you.
  
  
• Description of research studies - You may be asked before or after your procedure if you would like to participate in a research study. We believe research is important to our continued effort to improve care for the patients of tomorrow. However, you are not obligated to participate in any study, nor will your medical care be affected by your decision. Nonetheless, we would like you to make an informed decision. Should you have any questions about the research study you may decide to participate in, please feel free to ask your physician or the research associate during your visit.

During the Procedure

• Description of the room, monitoring devices, positions, and equipment that will be used - From the holding area, you will be taken to the operating room where the procedure will actually take place. The room will feel cool. You will lie on a table and you will be connected to equipment that will monitor your heart rhythm, blood pressure, and oxygen levels. A probe will be placed on your finger or ear lobe to constantly monitor your oxygen levels.
  
  Once you are in the operating room, the anesthesiologist or anesthetist will give you medication in your IV to sedate you. Once you are sedated, a breathing tube will be inserted through your throat into your lungs and you will be connected to a ventilator, which will breathe for you during the surgery. A tube will be inserted through your mouth into your stomach to drain your stomach fluids. A special IV will be placed into an artery in your wrist and connected to a monitor in order to monitor your blood pressure during the procedure. In addition, blood will be drawn from this special IV, called an arterial line, to check the oxygen levels in your blood during the operation.
  
  Another special type of IV will be inserted into your neck and connected to a monitor so that your heart's status can be closely monitored during and after the procedure. This neck IV is called a pulmonary artery catheter, because the tip of it is in the pulmonary artery.
  
  You will lie flat on your back during the entire procedure. The operating room is a sterile area, so everyone in the room will wear gowns, masks, and caps. The physician and assistants actually performing the procedure will wear sterile gloves.
  
  
• Anesthesia - You will be kept sedated during the operation and will not be aware of anything until two to three hours or more after the procedure has been completed.
  
  
• Basic description of the procedure:
  
  
  • Once all the preparations have been completed in the holding area, you will be taken by stretcher into the operating room.
    
    
  • The anesthesiologist or anesthetist will give you medication in your IV to sedate you.
    
    
  • Once you are sedated, a breathing tube will be inserted through your throat into your lungs and connected to a ventilator, or breathing machine. The ventilator will breathe for you during the procedure by moving oxygen and air in and out of your lungs.
    
    
  • An arterial line will be inserted into your wrist so that your blood pressure can be monitored during the surgery. Blood samples will be drawn from the arterial line periodically during the procedure to check the oxygen levels in your blood.
    
    
  • A pulmonary artery catheter will be inserted into a vein in your neck to help monitor your heart function during and after the procedure.
    
    
  • A catheter will be inserted into your bladder to drain urine during and after your procedure.
    
    
  • The heart surgeon makes an incision (cut) down the center of the chest from just below the Adam's apple to just above the navel.
    
    
  • The sternum (breastbone) is sawed in half with a special operating instrument. The surgeon then separates the two halves of the breastbone and spreads them apart to expose the heart.
    
    
  • Tubes are inserted into the chest so that the blood can be pumped through your body by a cardiopulmonary bypass machine.
    
    
  • Once the blood has been completely diverted into the bypass machine for pumping, the diseased heart is removed.
    
    
  • The donor heart is sewn into place. Once the new heart is in place, blood vessels are connected.
    
    
  • When the transplant procedure has been completed, the blood circulating through the bypass machine will be let back into the heart and the tubes to the machine removed. The heart will be shocked with small paddles to restart the heartbeat.
    
    
  • Once your new heart begins to beat again, the surgeon will observe the heart to assess the function of the heart and to make sure there are no leaks where the blood vessels are connected.
    
    
  • Temporary wires for pacing may be inserted into the heart. These wires can be attached to a pacemaker box and your heart can be paced, if needed, during the initial recovery period.
    
    
  • The sternum will be pushed back together and sewn together with small wires.
    
    
  • The skin over the sternum will be sewn back together.
    
    
  • Tubes will be inserted into your chest to drain blood and other fluids from around the heart. These tubes will be connected to a suction device to keep fluids pulled away from the heart.
    
    
  • You will be transferred from the operating table to a bed, then taken to the ICU.
    
    
• Procedure time - The procedure will take about three to six hours, depending on the complexity of the procedure.

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