In heart transplantation surgery the diseased heart is replaced by healthy heart obtained from human donor usually patients who are declared brain-dead but on life-support, having no heart diseases.
It is recommended as a treatment in patients with following conditions:
- End-stage heart and lung disease
- Complex congenital heart disease
- Eisenmenger syndrome (atrioventricular canal defect, transposition of the great vessels, and truncus arteriosus)
- Irreversible right-sided heart failure resulting from pulmonary hypertension.
Donor operative procedure
The patient is given general anesthesia and made comfortable throughout the procedure. The surgeon makes an incision through the centre of the breast bone for initial inspection of the heart and lungs. The heart and lungs are then mobilised without harming the lung tissues. The heart is flushed using cold cardioplegia solution and at the same time the lungs are flushed with cold, modified Collins solution. Then, the heart-lung block is removed and placed in a sterile, cold electrolyte solution for storage.
Recipient operative procedure
The surgical procedure in the recipient is performed under heart-lung bypass machine which maintains the blood circulation and oxygen levels of the body. The diseased heart and lungs are removed. The phrenic nerve and bronchial artery circulation is preserved so that post-operative complications are avoided. Then, the donor heart and lungs are inserted followed by fusing of the trachea, right atrium and aorta. After the completion of this procedure the heart-lung bypass support will be disconnected.
Risks and complications
Some of the potential risks and complications involved with heart and lung transplantation procedure include:
- Transplanted organ failure
- Rejection of the transplant
- Infection because of anti-rejection medications (reduce body’s ability to fight infections)
- Blood clots
Recovery from organ transplant takes a long span of about 6 months. Anti-rejection medications should be taken as prescribed to prevent rejection of the transplant. Frequent follow-up visits and routine blood tests will be necessary.
Ventricular Assist Devices
With heart failure, the heart becomes too weak to efficiently pump blood to other parts of the body. Some patients benefit from drug therapy. But others may require a heart transplant or other intervention. When heart failure reaches this advanced stage, it can be life-threatening. We care to help these patients live longer and enjoy a better quality of life.
Since there are not enough donor hearts to meet the needs of all the patients who require them, patients with end-stage heart failure may benefit from mechanical cardiac assist devices, the most common of which are ventricular assist devices (VADs). VADs can be used in patients as temporary support while waiting for heart muscle recovery, as temporary support while awaiting a heart transplant (“bridge to heart transplant”), and as “destination” (permanent) therapy for those who are not eligible for a transplant.
The left ventricle is the chamber responsible for pumping oxygen-rich blood from the heart to the aorta for transport to the rest of the body. Left ventricular assist devices (LVADs) take on the workload of the left ventricle, helping the heart to pump oxygenated blood to the rest of the body. As a result, all tissues and organs receive the blood supply they need to do their jobs. The patient feels better and can return home to live a better quality of life with family and friends.
In addition, some patients require support of the right heart as well, which pumps blood to the lungs, where it can receive oxygen. Right ventricular assist devices (RVADs) are commonly used in conjunction with LVADs, and are referred to as biventricular assist devices (or BiVADs).
We specialize in the implantation of a wide variety of VADs, selected and tailored for each individual patient and their particular situation. A multidisciplinary team — comprised of surgeons, cardiologists, nurses, physical therapists, psychiatrists, nutritionists, and social workers — assures that patients receive comprehensive care, both in the hospital and once they are discharged home.
The VAD consists of:
- A pump: The pump is implanted in or near the upper part of the abdominal wall and is connected to the heart at two points. A tube carries blood from the ventricle to the pump. The blood is pumped through a second tube to the aorta or pulmonary artery, and distributed to the lungs or throughout the body.
- An electronic control system: A third tube extends from the pump and contains wires that connect the pump to the electronic control system.
- A power supply (rechargeable batteries): The control system is connected to small batteries. Patients wear the controller on a belt and the batteries on a vest-like shoulder holster