Heart transplant is a surgical procedure carried out to remove a
damaged heart and replace it with a healthy heart donated by a donor. Getting a
donor heart is not an easy task. Usually
heart donated by a brain dead person who lives on life support is used if it
matches to the tissues of the acceptor
as closely as possible so that the chances of rejection of the heart does
not arise at all.
This procedure is carried out under general anesthesia putting
the patient to deep sleep. A cut is made through the breastbone. Your blood is allowed to bypass to a heart
lung bypass machine while the surgeon is carrying out his task. As the heart of
the patient has stopped working, its function is now carried out by the heart
lung bypass machine. Through this machine the patient’s body is getting oxygen
and blood.
Doctor now removes the diseased heart and stitches the donor
heart in place. After this the heart lung machine is disconnected. The blood
starts flowing through the new heart and it starts functioning as usual
supplying your body the required blood and oxygen. For several days tubes
inserted to your chest for removing air, blood and fluid will remain there itself till the lungs begins to
expand fully.
When is the
procedure necessary?
Heart transplant procedure is suggested by heart specialists
under the following circumstances to save the life of the patient.
1.
When heart is severely damaged after a heart attack
2.
When heart failure occurs after treatments and
surgical procedures
3.
For hearts which have severe defects at the time of
birth itself which cannot be fixed by any methods including surgical
procedures.
4.
Irregular heartbeats and rhythms not responding to any treatments
For whom it is not
suitable?
1.
Patients who are malnourished
2.
Patients who are above the age of 65-70
3.
Who have had stroke or dementia
4.
Who were cancer patients less than two years ago
5.
How are HIV positive
6.
Who have active hepatitis
7.
Who are diabetics and kidneys are affected by this
8.
Who suffer from diseases related to liver, lungs,
nerves etc.
9.
Who are not supported by family
10.
Patients who are alcoholics or smokers or other life
style problems that can affect the new heart.
11.
Patients who do not take care to follow the
instructions of the physicians
Risk factors
As in the case of any surgery there can be risks from anesthesia
as well as the surgical procedure. They are detailed below.
1.
Reactions to medicines
2.
Breathing problems
3.
Infection
4.
Bleeding
5.
Blood clots
6.
Kidney, lung, liver etc may be damaged due to
anti-rejection medicines
7.
Chances of development of cancerous cells as a
result of intake of medicines
8.
Stroke or heart attack
9.
Bone thinning, high cholesterol levels, diabetes
etc.
10.
Lung failure, liver failure, coronary artery disease
etc.
11.
Rejection of new heart
Preparing or the
operation
After finding out that heart transplant is unavoidable in a
case, the patient will be subjected to different tests to prove that he is a
suitable candidate for the procedure. If you are in a waiting list your position
on the list will depend upon the severity of your condition. A patient who is in the waiting list will be
contacted when a heart becomes available for him. As the donor heart has to be
transplanted within hours, the patient for heart transplant has to stay ready
waiting for the call. As preparatory task blood checking, electrocardiogram,
chest x-ray urine test etc would already have done and an intravenous line in
the arteries will always be there.
Operation
The patient will be administered with general anesthesia. Once
the patient is under deep sleep, the surgeon will place a tube through his
windpipe and connect it to respirator which is a breath supporting machine
intended to continue breathing process uninterrupted during the surgical
procedure. Another tube will be connected to your stomach to collect the liquid
and air accumulating in the stomach. This helps the patient in not feeling
bloated or sick after the procedure. Another tube will be inserted into your
bladder to collect the urine. For severally ill patients a mechanical heart
will be used to keep the heart functioning as the transplanting operation
progresses.
The surgery will last 3 to5 hours. A bypass machine will be used
to keep the pumping of blood uninterrupted. The old heart will be removed. The posterior
walls of the upper chambers known as atria are attached to the new heart. As a
precautionary step pacing wires will be connected to a pace maker placed
externally. These wires will be removed prior to discharge. After connecting
the new heart it is shocked so that it starts beating. The chest is closed.
When the patient awakes he will be in intensive care unit or
cardio vascular ICU. As you starts
breathing you will be detached from the ventilator the tube inserted to your
wind pipe will be removed. Pain medication will be administered either intra venous
or through medications. As you recover you will be shifted from ICU to your
room. Two to three weeks stay in hospital after surgery can be expected. Drugs
to prevent the rejection of the new heart by the patient’s body will be given.
The doctor will plan a rehabilitation program for your heart to recover faster
and become normal.
After reaching home the patient should be careful in detecting the possibility of infection by watching signs
like infection, shortness of breath, sore throat, redness or drainage from incision
etc.
Signs of rejection
of the heart
·
Weight gain
·
Shortness of weight
·
Fatigue
·
Fever
The surgeon will suggest
suitable drugs that can prevent the rejection of the new heart by the body. The
patient can return to normal life within three months of heart transplant
surgery. The patient will have to undergo cardiac catheterization every year to
prevent coronary disease. All patients have been found to live for 2 years and about
70 % of them are found to live for 5 years or more. If rejection can be
controlled by proper procedures the patient may live up to 10 years.
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