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Second chances: How new hearts save lives

» What happens before a heart transplant?

» How is the procedure performed?

» What happens afterward?

» What about complications?

» How is the new heart monitored?

Finding good candidates

Traditionally, people who benefit most from a transplant are under 65 and have irreversible heart disease with a life expectancy of less than three years.

Other than suffering from heart disease, a candidate must be in good health. Persons with active infections, severe obesity or other severe noncardiac diseases are not considered good candidates for heart transplantation. Doctors must also evaluate whether a person is able—and willing—to stick to the lifestyle changes required after a transplant, including long-term drug treatment and frequent examinations.

Bridge of hope: LVADs help heart patients stay alive

While heart transplant candidates await a donor heart, implantable left ventricular assist devices (LVADs) can help them lead near-normal lives for weeks, months and, in some cases, even years. LVADs have also been approved by the FDA as a long-term treatment option for patients who are not candidates for heart transplant. Simple devices made of metal and rubber, LVADs help a damaged heart pump blood to the body by taking over most of the work performed by the left ventricle, the chief pumping chamber.

Many patients who receive LVADs had impaired kidney or liver function as a result of their heart disease. But after receiving an LVAD, many recover some of the lost function, making them better heart transplant candidates.

Heart transplants have come a long way since 1967, when the first human heart transplant was performed. Once considered risky, today heart transplants are routinely performed when a person’s heart no longer works adequately because of irreversible damage from heart disease, viral infection or heart failure that doesn’t respond to treatments. People with dilated cardiomyopathy (an enlarged heart) with no known cause also can benefit.

Getting a heart transplant can reduce the problems caused by a diseased heart and can increase the survival rate of people with severe heart failure. The success of heart transplants improved when the drug cyclosporine came into use in 1983 to suppress rejection of a donor heart. Today, azathioprine and prednisone are also used to reduce rejection. Here are answers to common questions about heart transplants.

What happens before a heart transplant?

Before receiving a donor heart, possible candidates must undergo rigorous testing to determine whether a transplant is advisable and pass screenings for any conditions that might cause rejection of the new heart. Approved candidates are then placed on a waiting list and must remain within two to three hours’ distance of the hospital. The candidates carry a pager so that they may be contacted immediately when a matching donor heart is found.

How is the procedure performed?

During the operation, the patient is placed on a heart-lung machine, which takes over the job of pumping blood throughout the body. The surgeon then removes the patient’s heart by making incisions in the atria, aorta and pulmonary arteries. The donor heart is put in its place and reconnected to the sites where incisions were made. When blood vessels are reattached, blood flow is restored and the patient is removed from the heart-lung machine.

What happens afterward?

To assist recovery, a patient will have chest and upper abdomen drainage tubes kept in place for up to 48 hours to remove excess fluid remaining in the chest cavity. A breathing tube may also remain for a day or more until the patient can breathe unaided. Temporarily, the patient will receive water, food and medications intravenously, and recuperation at the hospital will last one to three weeks.

What about complications?

The most common complication is rejection of the new heart. This happens when the body’s immune cells identify the transplanted organ as foreign and try to destroy it. This can occur anytime after the transplant, which is why patients must take immunosuppressive drugs. But these drugs are something of a double-edged sword. Because they basically tell the immune system to hold off its attacks, the patient is at risk of severe infections. Doctors must balance the dose of immunosuppressive drugs so that a patient’s new heart is protected but his or her immune system is not completely shut down. It’s important for doctors to monitor heart transplant patients closely to prevent infections or to detect and treat them immediately.

How is the new heart monitored?

To watch patients for signs of heart rejection, small pieces of the transplanted heart are removed for examination. This procedure is called endomyocardial biopsy. If the biopsy shows damaged cells, the type of immunosuppressive drug or the dose may be changed. Biopsies of the heart muscle are usually performed once a week for the first six weeks, then every two weeks and then on a monthly schedule. After six months, the biopsies may be done every three to six months thereafter. Noninvasive tests now under investigation show promise for detecting rejection earlier and with less discomfort for patients.

© 2014 Dowden Health Media