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Before Surgery

When you get to the hospital, you'll be taken to CCU (Coronary Care Unit). After signing about a million consent forms, you'll have a physical exam. A chest x-ray, EKG, and some blood tests will be done.
     Several members of your transplant team will ask you questions to be sure there isn't any reason not to do heart surgery on you now. If you show any sign of an infection, your surgery will be cancelled. Besides the last minute blood tests, they will want a urine sample so do not empty your bladder before heading for the hospital!
     Now, it gets fun. You remove all unnecessary items, including dentures, contact lenses and cosmetics (including nail polish). You get to strip and scrub yourself from chin to toes. Next, you must shave yourself (or be shaved) from chest to knees (in case they need to harvest a vein from your groin or thigh).
     Now you get painted with an antibiotic solution that turns your skin a bright yellow or orange. Next, IV lines are inserted. A Swan-Ganz catheter is placed into the major vein in your neck (just like your previous right heart caths). This catheter will be used to measure pressures in various chambers of your heart and your pulmonary artery.
     While you are rolled into the OR (Operating Room) on a gurney, your family will be sent into the Heart Surgery Waiting Room. Be sure you have prepared everyone who will see you right after surgery - like your family - for the shock of your appearance. Right after surgery, nobody looks good. You will look grey, cold, and somewhat lifeless, with tubes everywhere and machines making scary sounds.
      The OR is pretty chilly, so ask for a blanket if you want one. Just relax because once the anesthesiologist gets to work, you won't remember a thing until after the surgery. You will be given immunosuppresive drugs before and during the surgery to start weakening your immune system. This prevents your body from rejecting the "new" heart. Rejection is explained on another page.

The Surgery

Heart surgery teamOnce you are asleep, the surgical team goes to work. Your breastbone is split in half, your old heart removed and the new one sewn into place. Although this is open heart surgery, heart transplant is not as technically demanding for the surgeon as most heart bypass surgeries. Your main coronary arteries will be connected to a heart lung bypass machine, which will put oxygen into your blood and pump it through your body for you while you have heart surgery. A perfusionist operates the heart/lung bypass machine during surgery (see the picture).

perfusionist Most heart transplant surgeries are done with a method called "orthotopic." Your heart is removed but the back half of both upper chambers (atriums) are left in place. The front half of the donor heart's atrium is sewed to the back half of yours, which was left in place. Then the donor heart's right atrium is sewed to the still-in-place back half of your original atrium. Once the heart is in place, the donor's main arteries - the aorta and pulmonary arteries - are sewn to yours. An electric shock starts the heart beating.
     Despite changes in surgical techniques, atrial arrhythmias and conduction problems make a permanent pacemaker implant necessary in 10% to 20% of heart transplant recipients. A new technique not yet considered standard may greatly reduce that number.

Recovery After Surgery

When you wake up, you will be in a special cardiac care unit. Tubes, wires and electrodes will be all over the place. There will be lots of beeping, electronic and mechanical sounds around you. Some may sound like warnings but this is normal. The number one thing to remember is to relax. It usually takes at least 24 hours to get most of the lines and tubes out, although some stay in longer than others. Things to expect include:

You will be kept in "isolation," meaning everyone who enters your room must scrub their hands, wear masks, gloves, gowns and hats. Until all your lines and tubes are removed, this is the rule.
     Once you are awake and strong enough to breathe on your own, the ventilator tube will be removed. You will be told (this isn't optional) to breathe very deeply and cough as hard as you can to bring up anything that has pooled in your lungs. This will also expand your lungs. It isn't any fun but is very important because heart surgery gives you a tendency toward collapsed lungs. Coughing up everything you can also helps prevent infection, and infection is your number one enemy from now on because you are on drugs that lower your ability to fight infections.
     Visiting hours are going to be few and far between for a day or two. It will be family only and they must be healthy, without any flu, colds, or other illnesses. They should wear freshly laundered clothes, and must wear the usual "isolation" gear described above.
     When your chest tubes are out, a physical therapist will immediately begin working with you to build up your strength. This is very important since prednisone lowers your bone density and only strength building will help slow that process.

When you're ready (or not <g>), you will be moved to a private room with looser visiting hours. Family members can then visit without the gown, masks and gloves, but they must still wash their hands every time they enter your room. You are now the one who has to wear a mask whenever you are in the hospital, including now. You should now be able to wear loose fitting clothing of your own, like sweats. Cleanliness is now a requirement - not an option - for you. You must keep yourself clean all the time to prevent infection.

Material taken from manuals given to potential transplant recipients at transplant centers in the USA, and from heart transplant recipients - Updated May 9, 2002

All information on this site is opinion only. All concepts, explanations, trials, and studies have been re-written in plain English and may contain errors. I am not a doctor. Use the reference information at the end of each article to search MedLine for more complete and accurate information. All original copyrights apply. No information on this page should be used by any person to affect their medical, legal, educational, social, or psychological treatment in any way. I am not a doctor. This web site and all its pages, graphics, and content copyright © 1997, 1998, 1999, 2000, 2001, 2002, 2003, 2004 Jon C.

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