Transplant
Introduction
Most heart transplants are done on patients who have end-stage heart failure, a condition in which your heart is severely damaged or weakened, and on people who have failed other treatment options. End-stage heart failure may be caused by conditions such as coronary heart disease, viral infections, or hereditary conditions. In rare instances, heart transplant may be performed at the same time as lung transplant in patients who have severe heart and lung disease.
Heart transplant surgery will be done in a hospital. You will have general anesthesia and will not be awake during the surgery. You will receive medicine through an intravenous (IV) line in your arm. A breathing tube connected to a ventilator will help you breathe. A surgeon will open your chest, connect your heart’s arteries and veins to a heart-lung bypass machine, and remove your diseased heart. The body’s arteries and veins will be taken off the bypass machine and reconnected to the healthy donor heart. The heart transplant is complete after the surgeon closes your chest.
Reasons for heart Transplant
A heart transplant is typically considered when all other options have been tried, but failed to completely improve the patient's condition. This is typically recommended for people who are suffering from heart failure, which can be caused by the following heart conditions:
a) Coronary artery disease
b) Valvular heart disease
c) Cardiomyopathy
d) Congenital heart defect
e) Failure of a previous heart transplant
Heart failure can affect anybody of any age. In children, the two common causes are congenital heart defect and cardiomyopathy. Meanwhile, adult patients who have had the Fontan procedure as a child may also be in need of a heart transplant later on in life. For these patients, the veins typically become congested, seriously affecting the blood flow.
Risk Factors
Risk factors include:
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Heart transplant has some serious risks. Primary graft dysfunction happens when the donor heart fails and cannot function. This is the most frequent cause of death for the first month after transplant. Your immune system also may reject your new heart. Rejection is most likely to occur within six months after the transplant. You will need to take medicines for the rest of your life to suppress your immune system and help prevent your body from rejecting your new heart. These medicines weaken your immune system and increase your chance for infection. Their long-term use also can increase your risk for cancer, cause diabetes and osteoporosis, and damage your kidneys. Cardiac allograft vasculopathy is a common and serious complication of heart transplant. Cardiac allograft vasculopathy is an aggressive form of atherosclerosis that over months or a few years can quickly block the heart’s arteries and cause the donor heart to fail. Over time, your new heart may fail due to the same reasons that caused your original heart to fail. Some patients who have a heart transplant that fails may be eligible for another transplant.
- Despite these risks, heart transplant has a good success rate that has improved over many decades of research. Recent survival rates are about 85 percent at one year after surgery, with survival rates decreasing by about three to four percent each additional year after surgery because of serious complications. Mechanical circulatory support, possibly from left ventricular assist devices, may be an alternative to heart transplant. But more research is needed to determine long-term survival rates for these new devices.
Procedure
Procedure include:
- With heart transplant being a major invasive surgery, patients usually start preparing for it weeks or months prior to the operation. Once the doctor recommends the procedure, the patient is immediately referred to a heart transplant centre for an evaluation to see whether he or she is eligible for the surgery. The evaluation procedure is designed to assess if the transplant is really the best treatment option and if the patient is physically, emotionally, and mentally prepared for whatever the operation entails.
- The next step for patients who are deemed suitable for the procedure is to wait for a donor heart to become available. As soon as a patient has been qualified for a transplant, he or she will be placed on a waiting list and his or her condition will be continuously monitored. A patient may be temporarily removed from the waiting list if something happens that affects his or her capability to accept the transplant. While waiting for a donor, devices such as ventricular assist devices (VADs) will be used to strengthen the heart and temporarily support the patient's life.
- Once a donor heart becomes available, a donor-recipient match will be made based on the following factors: a) Blood type b) Size of the donor heart c) Medical needs of the potential recipient d) Antibodies of the recipient e) Time spent by the recipient on the waiting list
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A donor heart can only be used for a transplant within four hours after it has been harvested from a recently deceased patient. Thus, it is usually taken to a transplant centre that is near the hospital where it came from. The patient on the waiting list will be notified via a mobile phone or a pager provided by the transplant centre.
The heart transplant surgery involves removing the patient's original heart by transecting the main pulmonary artery, aorta, and the superior and inferior vena cavae. The left atrium is then divided, while the back wall of the left atrium is left in place with the pulmonary vein openings. After removing the diseased heart, the cardiologist connects the donor heart to the body by sewing its vena cavae, aorta, pulmonary artery, and left atrium.
Range of Treatment Cost
| Procedure | Duration In Hospital | Min Cost (INR) | Max Cost (INR) |
|---|---|---|---|
| Heart Transplant for Related Donor and Recipient | Depends upon the treatment | 3000000 | 4000000 |
