About heart transplant surgery

In the months, weeks, and days leading up to heart transplant surgery, it's a good idea to become familiar with what to expect afterward. The highlights below can help set expectations.

Before surgery

When it comes to heart transplant surgery, the procedure is typically done by orthotopic approach. Surgery will vary for every patient. Families should talk with their surgeon about what to expect.

Heart surgery approach:
  • Orthotopic — here, the recipient's heart is replaced with the donor heart.

During surgery

Following arrival at the hospital and necessary surgical preparations, your transplant team will perform the following surgery approach:

Orthotopic transplantation
  • First, you'll receive general anesthesia.
  • A bypass machine will be hooked to the arteries and your veins so oxygenated blood can keep flowing throughout the body.
  • The surgeon will open your chest cavity.
  • The diseased heart will be removed and the donor heart will be put into place.
  • The new heart should start beating after blood flow is restored.

After surgery

The period immediately after heart transplant surgery is a very critical time for you. Your transplant team will monitor you very closely. As your condition begins to stabilize, you and your family will be taught about medications, diet, and other important issues.

Watching for a heart rejection

It is important to remember that transplantation is a serious surgery and risks still remain. One of the more common complications of transplantation is rejection. However, thanks to anti-rejection medications, rejection episodes are less common and can usually be managed.

In transplanted hearts, the sensory nerves are no longer intact, so there are usually no obvious symptoms that you can feel when there is a problem. This is why people with heart transplants must see their doctor regularly to have their heart biopsied. Often, this is the only way to be certain that rejection or infection is occurring.

  • If you notice any of the following symptoms, call your transplant team right away:
  • Fever over 100°F (38°C)
  • Flu-like symptoms such as chills, nausea, vomiting, diarrhea, tiredness, headache, dizziness, or body aches and pains
  • Coughing up yellow or green mucus
  • A dry cough that lasts for more than 1 week
  • Severe diarrhea
  • A burning feeling when you urinate
  • Vaginal discharge or itching
  • A wound that oozes fluid, does not heal, or feels warm
  • Swelling, warmth, redness, pain, or tenderness of an arm or leg
  • Pain or tenderness over your transplant site
  • Retaining fluids or having sudden weight gain
  • Shortness of breath
  • Sudden rise in blood pressure
  • Change in pulse rate
  • Tiredness
  • Lower amount of urine

As you know, heart rejection is serious. That makes taking your anti-rejection medication directly as prescribed serious as well. Make sure you take the same anti-rejection medicine each time, unless your doctor tells you otherwise.

Watching for a heart transplant infection

The medications you take to prevent heart rejection work by slowing down your body's immune system. While they help to prevent rejection of your new heart transplant they also lower your body's ability to fight infections.

To help lower the risk for infection, you may be prescribed preventive medications. Because your risk for infection will go down over time, your transplant team may decide to lower the amount or dose of preventive medications that you require.

  • Here are some things you can do to help further reduce your risk of infection:
  • Scrub your hands often, especially before eating and after using the bathroom or touching animals.
  • Keep fingernails short and always use clean nail clippers.
  • Wear gloves when gardening to avoid bacteria in plants and soil.
  • Practice good oral hygiene to prevent mouth sores.
  • Avoid raw or partially cooked foods and unwashed fruits and vegetables.
  • Avoid take-out and deli foods (foods sitting at room temperature can develop bacteria).
  • Notify a member of your transplant team if you have been around anyone with a contagious illness (flu, chicken pox, etc.) or anyone who recently received a live vaccine, such as the polio vaccine.

Infections can become very serious and can even lead to death if left untreated.

  • Contact your transplant team right away if you have any of the following symptoms:
  • Fever over 100°F (38°C)
  • Flu-like symptoms such as chills, nausea, vomiting, diarrhea, tiredness, headache, dizziness, or body aches and pains
  • Coughing up yellow or green mucus
  • A dry cough that lasts for more than 1 week
  • Severe diarrhea
  • A burning feeling when you urinate
  • Vaginal discharge or itching
  • A wound that oozes fluid, does not heal, or feels warm
  • Swelling, warmth, redness, pain, or tenderness of an arm or leg