Heart Transplant: The Ultimate Solution for End-stage Heart Failure

heart transplant surgery

Did you know?

  • The first-ever heart transplant was carried out by Dr. Christiaan Bernard, a South African surgeon on December 3, 1967, at the Groote Schuur Hospital in Cape Town.
  • Louis Washkansky is a 53-year-old patient who had end-stage heart failure due to coronary artery disease.
  • The donor was Denise Darwell, a 25-year-old woman who died in a car accident.
  • The surgery was successful, but Washkansky died 18 days later from pneumonia.

Let’s first understand why the need for a heart transplant rises.

Heart failure is a condition when the heart is not able to pump enough blood to meet the body’s requirements.

Heart failure is caused by various factors such as:

  • Weak heart muscles (cardiomyopathy)
  • Coronary artery disease is caused by blocked arteries that supply blood to the heart.
  • Heart valve disease (problems with the valves that regulate blood flow in the heart)
  • A congenital heart defect (a birth defect that affects the structure or function of the heart)
  • An abnormal heart rhythm (arrhythmia) that cannot be controlled by other treatments.

Some of the symptoms of heart failure are shortness of breath, fatigue, swelling in the legs or abdomen, chest pain, irregular heartbeat, coughing or wheezing, and reduced ability to exercise or perform daily activities.

People with heart failure may be able to control their condition with medicine, changes in lifestyle, and less invasive procedures such as ventricular assist devices (VADs) or implanted devices. 

However, for people who have end-stage heart failure, their condition is so severe that they may die without a new organ, their only option is a heart transplant.

Heart transplant surgery is a life-saving procedure that replaces a damaged heart with a healthy donor heart.

The International Society for Heart and Lung Transplantation (ISHLT) estimates that, as of 2020, more than 150,000 heart transplants have been carried out worldwide.

What is a heart transplant?

It is a surgical procedure where a diseased or unhealthy heart is removed from a patient and replaced with a donor’s heart who has agreed to donate his or her organ.

Here the condition is that the donor’s heart must match the patient’s blood type and body size and must be available within a short time after the donor’s death.

There are two different surgical approaches to heart transplantation:

  • Orthotopic and,
  • Heterotopic

In orthotopic transplantation, the patient’s entire heart is removed and replaced with a donor heart.

In heterotopic transplantation, the patient’s heart is left in place and a donor’s heart is attached to it, creating a “double heart.” This method is less common and is used for patients who have high blood pressure in their lungs (pulmonary hypertension) or who have a donor heart that is too large or small. The procedure usually takes 4 to 6 hours.

Who needs a heart transplant surgary?

Some of the criteria that doctors use to determine who needs a heart transplant are:

  • The severity of symptoms, such as shortness of breath at rest or with minimal activity
  • Results of tests measuring heart function, such as ejection fraction, cardiac output, or pulmonary artery pressure.
  • Reaction to medicines or devices that help the heart pump better.
  • Presence of other medical conditions that may affect the outcome of the transplant. These may include kidney disease, liver disease, lung disease, cancer, or infection.

Not everyone suffering from end-stage heart failure is a good candidate for a heart transplant. Some factors that make you unsuitable for a transplant are:

  • If you are over 65 years of age.
  • If you have an active infection or cancer that is causing damage to other organs.
  • If you have a history of non-compliance with medical treatment.
  • If you are addicted to alcohol, drugs, or tobacco.
  • If you have a poor psychosocial support system.

How does a heart transplant work?

heart transplant survival rate

A heart transplant is a complex and risky procedure that requires a team of experts and careful preparation. It is performed by a team of special doctors, nurses, and other health professionals. The process usually takes several hours and involves the following steps:

  1. Before surgery, the patient undergoes a number of tests to determine their eligibility and readiness for the procedure.
  2. First, the patient is given general anesthesia. Then the doctor connects to a heart-lung bypass machine, which takes over the function of the heart and lungs during the surgery.
  3. Then the surgeon makes an incision in the chest and removes the unhealthy heart.
  4. The surgeon connects the donor heart to major blood vessels and restores blood flow to the new heart.
  5. The surgeon checks whether the new heart is beating normally. If it’s beating normally then the doctor disconnects the bypass machine.
  6. The surgeon closes the chest incision and covers it with a sterile dressing.
  7. After surgery, the patient is moved to the intensive care unit (ICU) where they are closely monitored for any signs of risks such as bleeding, infection, rejection, or arrhythmia.
  8. The patient may have to stay in the hospital for several weeks before going home.

How long can one with a heart transplant survive?

The surgary can significantly improve the quality and quantity of life for people with end-stage heart failure. However, it is not a cure and it comes with its own challenges and complications.

The survival rate of patients depends on many factors, such as age, health status, donor organ quality, surgical technique, immunosuppression regimen, and post-transplant care.

According to the International Society for Heart and Lung Transplantation (ISHLT), the average survival rate of adult heart transplant patients is:

  • 85% at one year
  • 75% at three years
  • 69% at five years
  • 57% at 10 years

The survival rate of pediatric heart transplant patients is slightly higher, with an average of:

  • 87% at one year
  • 83% at three years
  • 77% at five years
  • 67% at 10 years

These numbers are based on data from more than 100,000 heart transplants performed worldwide between 1982 and 2016. The survival rate may vary depending on the individual circumstances of each patient and the transplant center.

What are the risks of heart transplant surgery?

Heart transplant surgery is a major operation that carries many risks. The risk varies depending on the age and health status of the patient.

Some of the risks include:

  • There can be bleeding or infection during or after surgery.
  • Can damage other organs or tissues during surgery.
  • The immune system of the patient might Reject the donor’s heart.
  • Side effects of immunosuppression medications.
  • Abnormal heart rhythm in the donor’s heart can affect the Heart’s pumping ability or cause sudden cardiac death.
  • Graft failure or primary graft dysfunction is a rare but serious condition in which the donor’s heart does not work properly immediately after surgery.
  • Graft-versus-host disease (GVHD), is a rare but serious condition in which the donor immune cells attack the recipient’s tissues and organs.

How much does a heart transplant cost?

The cost may vary depending on the country, region, hospital, Insurance coverage, and other factors.

According to a 2017 report by Milliman Research Reports, based on data from US hospitals in 2014, the average cost was:

  • $997,700 for pre-transplant evaluation and testing
  • $1,377,800 for hospital admission for transplant
  • $30,900 for procurement (procurement and transportation) of the donor organ
  • $133,700 for immunosuppression drugs in the first year after transplant
  • $23,400 for physician services for transplant

The total average cost for one year after transplant was $2.5 million. It does not cover additional fees for things like follow-up care for longer than a year, wage loss, or travel.

If you have health insurance then the cost may be covered by your insurance plans depending on their policies and eligibility criteria. Some patients may also qualify for financial assistance from government programs or charitable organizations that assist with medical expenses.

The recovery period after the surgery

Recovery from the surgery can vary depending on each person’s condition and progress. Typically, patients start walking within a few days after surgery and can leave the hospital in 10 to 14 days. They need to be in touch with their transplant team for regular tests and checkups to monitor the functioning of their new heart and prevent any risks.

Most patients start feeling healthy and strong again about 6 months after surgery. However, they will need to take lifelong medications to prevent rejection of his new heart and protect himself from infection. They also need to adopt a healthy lifestyle that includes eating well, getting regular exercise, quitting smoking, managing stress, and avoiding alcohol.

Cause of Death after surgery

Heart transplantation can significantly improve survival for people with end-stage heart failure.

The main causes of death after heart transplantation are:

  • Rejection
  • Infection and
  • Coronary artery disease (CAD)

Rejection can occur at any time after surgery but is more common in the first year. This may cause symptoms like fever, fatigue, shortness of breath, or chest pain. Rejection can be detected by routine tests and treated with medications or other treatments.

Infection is another serious risk that can affect people who have had a heart transplant. They are more vulnerable to infection by bacteria, viruses, or fungi. The infection can affect any part of the body, but especially the lungs, kidneys, or bloodstream.

Infection can be prevented by practicing good hygiene, avoiding contact with sick people, and taking prophylactic antibiotics.

CAD is a condition that affects many people who have had a heart transplant. It occurs when plaque builds up in the arteries that supply blood to the heart muscle, causing them to narrow and reducing blood flow. This can cause chest pain, angina, or even heart attack. It develops faster and more severely in people who have had a heart transplant than in people who have not had a heart transplant.

It can be prevented by controlling risk factors such as high blood pressure, high cholesterol, diabetes, smoking, and obesity.

The Bottom Line

Heart transplantation is a life-saving treatment for people with end-stage heart failure who have exhausted all other options. It involves replacing an unhealthy heart with a healthy one.

It also involves many risks and challenges such as finding a donor, undergoing surgery, preventing rejection, infection, and CAD, and taking lifelong medications. Therefore, it is important to carefully weigh the benefits and risks and follow medical advice and care plans diligently.

1 thought on “Heart Transplant: The Ultimate Solution for End-stage Heart Failure”

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