What is the procedure for a heart-transplant operation?

Question

I wanted to know what the actual procedure was during the operation. I was told it could take between 3-7 hours, and that they have to cut your chest and then get through the ribs somehow, and then stitch in the new heart. Can anyone help out with more details, and names of intruments used, etc? Any comments from actual doctors would be especially great! How do they replace the heart without the patient dying? Thanks!!!

Answer 1

The procedure is nicely explained by the following animation

http://www.pbs.org/wgbh/nova/eheart/transplant.html

Essentially the procedure is

Make an incision in the chest down to the breastbone then cut with a saw. Retract the breastbone then cut through pericardium to heart. Attach bypass machine then turn it on so heart is bypassed. Make incisions in major blood vessels so that only a small amount of the heart remains. Then suture the new heart in place. Remove the clamps on blood vessels and turn off bypass blood should flow into the new heart. If it does not restart automatically use a defibrillator. The answer to your second question about the patient dying is that during the operation the heart is bypassed. Blood returning to the heart is taken away by tubes to a bypass machine that oxygenates it and then returns it to the aorta the major artery of your body. By doing this the heart and lungs are bypassed and blood continues to circulate around the body.

Answer 2

I don't know a huge amount about this but I do know that they "piggyback" the new heart into place so that the old heart is still there too.
I hope you find out the rest of the information that you want to know.

Answer 3

I don't think this is the correct place to learn how to perform a heart transplant. Have you considered medical school?

Answer 4

oh no is spot on almost word perfect,, give the dude the points
thanks

Answer 5

http://www.pbs.org/wgbh/nova/eheart/transplantwave.html

Answer 6

Heart transplants have been perfected over many years. The following is an example of what will happen:

When an organ that meets your requirements is located, you will be called into the hospital by the nurse coordinator. The transplant doctors will be checking the donor organ while you are being evaluated and started on medications in preparation for transplantation. If the donated organ is good, you will then be taken to the operating room, put to sleep with an anesthetic, and one of the transplant surgeons will begin the process of preparing the chest cavity for removal of your heart.

The surgeon will begin by exposing the chest cavity through a cut in the ribcage. The surgeon will then open the pericardium (a membrane that covers the entire heart) in order to remove your diseased heart. The back part of your own left atrium will be left in place, but the rest of the heart will be removed.

Your new heart will be carefully trimmed and sewn to fit the remaining parts of your old heart. This transplant method is called an "Orthotopic procedure". This is the most common method used to transplant hearts.

You will be given medications both before and during the operation to prevent you from rejecting the new heart. After the operation, you will be taken to a special unit and hospital floor for recovery. You will stay in the hospital until your doctor believes you are ready to go home. How long you stay in the hospital will depend on the following factors:

Your health
How well the new heart is working
Your ability to learn to take care of your new heart transplant

You will wake up in the intensive care unit (ICU) after surgery. Around you, you will have lots of machines, tubes and people. You will hear lots of beeps, bells, and talking. You will have a tube in your mouth and throat that helps you to breathe but keeps you from being able to talk. You cannot eat or drink anything while the tube is in your mouth. You will have intravenous lines in the veins of your arms and your neck that will give you fluid and medications. You will feel a tube (one or two) coming from your chest which is draining fluid that can collect there. A large dressing will be covering the wound on your chest from the surgery. You will notice wires on your chest which connect you to a monitor so that your nurse can see how your heart is working. You will have a catheter in your bladder to continuously empty it.

All of these tubes and wires make it difficult to move, but they are necessary right after surgery. We try to remove them as soon as possible, however, in order to cut down on the chance of infection. As a result, a lot of tubes will be removed within the first day or two days after surgery depending on your condition. You may also find that you are unable to move because of medications given to you during the surgery. Do not worry. The effects of the medications will wear off. In terms of pain, most transplant patients say that it is not as bad as they thought it would be.



Among all of the people moving around you, there will be one nurse who is assigned just to you. All of the nurses are specially trained in the care of transplant patients so you will be in good hands. If you are worried about being unable to talk with the tube in your mouth, stop worrying. The nurses have lots of experience with that and will be able to meet all of your needs.

While you are in the ICU, blood tests, EKGS, and chest x-rays will be done frequently to follow your progress. Some of the drugs you will be taking affect the blood components and we want them to remain in the normal range

Your nurse and the respiratory therapist may frequently do what they call "chest PT" on you. This involves placing you on your side and then clapping and vibrating their hands on your back. The sound can be very loud, but it does not hurt. What they are doing is loosening any mucus that may be in your lungs and airways so you can cough it up. This helps to cut down on the chance of you getting a lung infection.

After surgery, you take medication to prevent rejection. A side effect of this medication is a lowering of your body's ability to fight off infections. To protect you from infections of other patients, staff, and visitors, you will be in a room by yourself during the first few days after surgery. All persons entering your room must wash their hands well; wear a mask and gloves.

After a week or ten days, you may be moved to another area of the hospital called the Cardiothoracic Unit next to the ICU. If you go outside your room, you will need to wear a mask and gloves to avoid picking up germs that could cause an infection. Please avoid any other patients who have infections.



The decision to receive a transplant is a major one and should not be made without a great deal of thought for several reasons:

First, transplantation is a major surgical procedure that involves some degree of risk. Specific information about the risks and major complications associated with the surgery will be discussed with you during your evaluation period.
Second, transplantation requires a serious and definite commitment by you and your family to the maintenance of a strict posttransplant regimen. This regimen will need to be followed for the rest of your life. Many patients find that following the strict diet, medication, exercise, and clinic regimen requires changes in their lifestyle. All of the medications prescribed are necessary and must be taken at specific times. Your diet may restrict calories, fluids, salt, fats, cholesterol, and carbohydrates. Also, you will not be able to drink alcohol, as it will affect your immunosuppressant levels. You will need to exercise daily to keep your body strong. You will be expected to visit the clinic as directed for follow-up examinations, medication adjustments and testing.
Third, the medications you must take after the transplant have certain side effects that can be unpleasant and can cause other medical problems. Some of the medications that prevent your body from rejecting the new organ can also decrease the ability of your body to fight off infection, can raise your blood pressure, or can cause your bones to become weak due to loss of calcium (osteoporosis). During your evaluation, you will learn more about other possible drug side effects. Please remember that not all patients will have the same side effects.
Because these medications are necessary in order for a transplant recipient to survive, some side effects are unavoidable. The risks associated with the use of these medications can be reduced only by learning about them, taking them as ordered, and by careful monitoring during clinic visits. The transplant team will work closely with you and your family to teach you what you need to know to live successfully with a transplant. Your transplant team's hope is that you will be able to live an active and productive life after you receive a new organ.



You will be discharged as soon as the transplant team feels that it is safe for you to live outside of the hospital. This decision is based on how you have recovered since surgery, the status of your biopsy reports, and the number of severity of any rejections or infections you have had.