Heart Transplant: Specialists & Surgical Information

The heart is responsible for supplying the body’s organs and tissues with oxygen-rich blood. Without oxygen, the cells would quickly die. To do this, the heart must pump the blood—which has been enriched with oxygen in the lungs—through the arteries that lead all the way to the extremities.

Therefore, the heart must function continuously throughout a person’s entire life, day and night.

If the heart cannot perform this function—or cannot do so adequately—the patient needs a replacement heart. During a heart transplant, surgeons remove the failing heart and replace it with the heart of a deceased donor.

A heart transplant is usually a last resort for advanced heart failure. It is performed only after all other treatments—such as medications, pacemakers, or oxygen therapy—have failed.

The causes of severe heart failure vary. Some children are born with serious heart defects. In such cases, it is often clear from the outset that only a transplant can help. In adults, the most common causes of heart failure are:

• coronary artery disease (hardening of the coronary arteries, which supply blood to the heart muscle),
• heart muscle diseases (cardiomyopathies),
• narrowed or malfunctioning heart valves (in such cases, the correct amount of blood is not pumped through the body, and the heart sustains further damage over time), and
• systemic storage diseases (various substances are deposited in the heart and progressively impair its function).

These conditions are referred to as chronic, or persistent, heart failure.

In addition, there are diseases that cause acute rather than chronic heart failure. In such cases, the heart fails within a few hours or days. However, since patients almost always have to wait a long time for a donor organ, those with acute heart failure are usually not eligible for surgery.

Before surgery, the patient is first placed on a waiting list for a donor heart. Since far fewer hearts are donated than are needed, this waiting period can last several months or even years.

During this waiting period, cardiac support systems are often used, such as artificial heart pumps or mini-defibrillators. These devices can often ensure the patient’s survival for several years until a suitable donor organ is found.

Since a donor heart cannot be preserved for long, the surgery must be performed within a few hours. The sooner the heart is implanted, the better it will function later on. Anyone waiting for a new heart must therefore be reachable at all times and prepared for a prolonged hospital stay.

Once a donor heart is available, the patient must arrive at the transplant center as quickly as possible. There, several tests are conducted to rule out acute illnesses and prepare for the surgery. At the same time, the donor heart is transported to the hospital by the fastest means possible.

If the tests are successful, the surgery can begin within a few hours. First, the patient’s chest is opened and a heart-lung machine is connected. This device takes over the heart’s function during the surgery and ensures that blood continues to flow through the body.

In most cases, the patient’s diseased heart is then disconnected from the aorta and removed from the body. However, there are also surgical procedures in which the weakened heart remains in the body initially to provide support.

In both cases, the next step is to implant the prepared donor heart and connect it to the blood vessels.

Blood is then directed into the donor heart to warm it up. In most cases, it begins to beat on its own once it reaches its operating temperature.

Such an operation typically lasts between three and four hours.

Once the surgery is successfully completed, the patient is initially monitored in the intensive care unit. Special attention is paid to other organs, such as the liver and kidneys. Complications may arise here initially due to reduced blood flow.

From the very beginning, it is important to take immunosuppressants. These medications suppress the immune system and ensure that the body does not reject the foreign tissue.

After a while, the patient is transferred to a regular ward. Patients are usually discharged from the hospital after a few weeks. Most then go on to a rehabilitation clinic. Regular checkups at the transplant center are necessary during the first few months after surgery.

A heart transplant is a complex procedure that carries many risks. The risk of the body rejecting the donor heart is particularly high. To prevent this, patients must take immunosuppressants for the rest of their lives.

Optimal dosing of the medications is essential: on the one hand, they must reliably prevent rejection of the new organ; on the other hand, they must not suppress the immune system too much, so as to avoid secondary complications. Even with proper management, health risks cannot be completely prevented.

Possible side effects include, among others:

• an increased susceptibility to viral, bacterial, or fungal infections,
• kidney damage,
• elevated blood lipid and blood pressure levels,
• increased blood sugar levels and an increased risk of diabetes,
• decreased bone density and an increased risk of osteoporosis,
• long-term increased risk of tumor formation.

The risk of these side effects can be minimized by

• a healthy lifestyle,
• thorough hygiene,
• preventive medications, and
• regular checkups.

Despite these risks and limitations, most patients consider life with their new heart to be a great gift. After the recovery and adjustment period during the first few months, most patients experience a significant improvement in their quality of life and sense of well-being.

With their new heart, they are once again able to lead a largely normal life.