These factors can greatly affect how you do after the transplant. Blood tests. You will need blood tests to help find a good donor match and help improve the chances that the donor heart will not be rejected. Diagnostic tests. You will need tests to assess your lungs as well as your overall health. Women may get a Pap test, gynecology evaluation, and a mammogram. Other preparations. You will get several vaccines to decrease the chances of developing infections that can affect the transplanted heart.
The transplant team will consider all the information from interviews, your health history, the findings from your physical exam, and your diagnostic test results when deciding if you are eligible for a heart transplant. Once you have been accepted as a transplant candidate, you will be placed on the United Network for Organ Sharing list. When a donor organ becomes available, candidates are selected based on the severity of their condition, body size, and blood type.
If the heart is to be yours, you will need to go to the hospital right away so you can get ready for the transplant. These things will need to be done before the transplant: Your healthcare provider will explain the procedure and let you ask questions. You will be asked to sign a consent form that gives your permission to do the surgery. Read the form carefully and ask questions if anything is unclear.
You should not eat or drink anything fast as soon as you have been told that a heart has become available. You may be given medicine to help you relax sedative. Based on your health condition, your healthcare provider may request other specific preparation. What happens during a heart transplant? A heart transplant requires open heart surgery and a stay in a hospital. Procedures may vary depending on your condition and your healthcare provider's practice.
Generally, a heart transplant follows this process: You will be asked to remove any jewelry or other objects that may interfere with the procedure. You will change into a hospital gown. A healthcare professional will start an intravenous IV line in your hand or arm to inject medicine and to give IV fluids.
Additional catheters will be put in blood vessels in your neck and wrist to monitor the status of your heart and blood pressure, and to take blood samples. Other sites for the additional catheters include the under the collarbone and the groin. A soft, flexible tube Foley catheter will be put into your bladder to drain urine.
A tube will be put through your mouth or nose into your stomach to drain stomach fluids. If there is a lot of hair on your chest, it may be shaved. Heart transplant surgery will be done while you are in a deep asleep under general anesthesia.
Once you are asleep, a breathing tube will be put through your mouth into your lungs. The tube will be attached to a machine ventilator that will breathe for you during the surgery. The anesthesiologist will watch your heart rate, blood pressure, and blood oxygen level during the surgery. The skin over your chest will be cleaned with an antiseptic solution. The surgeon will make a cut incision down the center of your chest from just below the Adam's apple to just above the navel.
The surgeon will cut the breastbone sternum in half. He or she will separate the two halves of the breastbone and spread them apart to reach your heart. The surgeon will put tubes into your chest so that your blood can be pumped through your body by a heart-lung cardiopulmonary bypass machine while your heart is stopped and replaced.
Once the blood has been completely diverted into the bypass machine and is being pumped by the machine, your doctor will remove the diseased heart. The surgeon will sew the donor heart into place. Once your new heart is in place, he or she will connect the blood vessels carefully so there are no leaks. When your new heart is fully connected, the blood circulating through the bypass machine will be allowed back into the heart and the tubes to the machine are removed.
Your surgeon will shock the heart with small paddles to restart the heartbeat. Wires for pacing may be put into the heart. Your surgeon can attach these wires to a pacemaker outside your body for a short time to pace your new heart, if needed, during the initial recovery period. The surgeon will rejoin the sternum and sew it together with small wires.
The surgeon will sew the skin over the sternum back together. He or she will use sutures or surgical staples to close the incision.
Tubes will be put into your chest to drain blood and other fluids from around the heart. These tubes will be connected to a suction device to drain fluids away from the heart as it heals. A sterile bandage or dressing will be applied. It's crucial that you get to the hospital right away. We ask people on the heart transplant waiting list to be within four hours of UPMC. In the meantime — to make sure you're in good health with no active illnesses — you'll:.
Before moving you to the OR, the anesthesiologist will speak with you about what to expect. You'll receive general anesthesia and sleep through the heart transplant procedure. You will also speak to one of the surgical team members to get consent for the transplant to take place. The amount of time for a heart transplant depends on the complexity of your case and if you need other procedures. If you do not have a VAD, surgery should take three or four hours.
If you have a VAD that needs to be removed, or you've had prior chest surgeries, it should take six to eight hours. You may be in the OR longer than the actual procedure because the transplant team must work with the donor site. While the length of survival for a transplanted heart continues to improve, the current median amount of time at our center is nine years, with the longest ever recorded at our center being 36 years and 10 months.
After a donor heart is placed into an open chest, the surgeon attaches it to the surrounding major blood vessels. It should usually start beating once blood flow is restored, but an electric shock can be used to get it started if necessary. Also called a cardiopulmonary bypass machine, this is what replaces the heart's pumping motion while it is outside of the body.
It also adds oxygen to the blood and performs the job of the lungs. But some will die before a heart becomes available to them. This means that more sick patients who are eligible based on strict criteria may be able to receive one. A limited number of programs in the U.
Yale Medicine is one of them. DCD is a more intense process. DCD organs and recipients must meet strict eligibility criteria, and the process of retrieving the heart involves multiple doctors.
Maulion says. When a DCD heart becomes available, however, Drs. Maulion and Anwer, as well as two perfusionists are sent to retrieve it. Once the heart is removed, it is reanimated and preserved in a warm environment with circulating oxygenated blood.
Only a few transplant centers those participating in the ongoing clinical trial are able to use this system to procure and then transplant hearts. While there is still more to learn, outcomes from DCD heart surgeries are proving to be comparable to those using organs from DBD donors.
These drugs have vastly improved in the last 15 to 20 years. The drugs can have adverse effects, including high blood pressure , as well as blood sugar and kidney problems. One notable advance is that doctors can now tailor an immunosuppression strategy for each patient, says Dr. Yale Medicine doctors have performed almost 10 heart—kidney transplants in the past two years, which is significant for almost any center, says Dr.
Surgeons perform the heart transplant first and the kidney transplant a day or more later.
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