Heart-Lung Transplant

Definition

A surgical procedure designed to remove severely diseased and damaged heart and lungs and replace them with a healthy heart and lungs from a donor who has recently died.

The Heart and Lungs

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Parts of the Body Involved

Heart, lungs, chest

Reasons for Procedure

A heart-lung transplant is done to treat irreversible, life-threatening lung diseases that affect the heart and cannot be managed using any other medical or surgical treatment. Transplant recipients are severely disabled by their heart-lung condition but otherwise are in good health. The procedure is most often performed on patients with severe pulmonary hypertension (an increase in blood pressure in the lung's blood vessels), either acquired or due to a birth defect.

Risk Factors for Complications During the Procedure

What to Expect

Prior to Procedure

Because of a shortage of donors, you may be on a transplant list for some time. You may need to carry a pager or cellular phone at all times so that the transplant team can reach you if donor organs become available.

Your doctor will likely do the following:

  • Physical exam
  • Order appropriate blood tests to ensure your liver and kidney are functioning normally
  • Have your blood typed and ready for surgery
  • Tissue typing

In the days leading up to your procedure:

  • Arrange for a ride to and from the hospital.
  • Arrange for help at home after returning from the hospital.
  • Take medications as directed and do not take over-the-counter medications without checking with your doctor.
  • The night before, have a light meal and do not eat or drink anything after midnight unless told otherwise by your doctor.

During Procedure

  • IV fluids
  • Oxygen
  • Anesthesia
  • Diversion of blood circulation through a heart-lung machine

Anesthesia

General

Description of the Procedure

The surgeon cuts through the skin and breastbone, opens the chest, and connects you to a heart-lung machine. This machine takes over the functions of the heart and lungs during the operation. Doctors remove the lungs and all but the back walls of the upper chamber of the heart. The donor lungs are attached, then the upper chambers of the donor heart are opened, and it is sewn into place. Next, the blood vessels are connected, and the blood starts to flow and warms the heart.

The new heart may begin beating on its own or doctors may administer an electrical shock to get it started. Once the doctors are sure no leaks exist and the heart and lungs are working fine, the heart-lung machine is disconnected, the breastbone wired together, and the chest closed. You will have many tubes and lines on your chest and body to monitor your heart and blood pressure.

After Procedure

You'll be closely monitored in the intensive care unit, with the help of the following devices:

  • Heart monitor
  • Pacing wires to help control heart rate
  • Tubes connected to a machine that helps drain excess blood and air
  • Breathing tube until you can breathe independently, then an oxygen mask

How Long Will It Take?

Several hours

Will It Hurt?

Anesthesia prevents pain during surgery. You'll likely experience some pain while recovering but receive drugs to relieve the discomfort.

Possible Complications

  • Infection
  • Rejection of the donor heart or lungs
  • Coronary artery disease (half of all heart-transplant recipients develop coronary artery disease)
  • Pneumonia
  • Phlebitis (blood clots of a vein)
  • Excessive bleeding
  • Neurological deficits, stupor, coma , decreased intellectual function
  • Kidney dysfunction
  • Irregular heart rate
  • Anesthesia-related problems
  • Cancer related to taking immunosuppressant medications
  • Death

Average Hospital Stay

Two weeks, if there are no signs of rejecting the new organs

Postoperative Care

  • Breathe deeply and cough 10-20 times every hour.
  • Take immunosuppressive drugs and other medications as directed by your doctor; only take drugs approved by your doctor.
  • A specialist who deals with immunosuppressive drugs will monitor your medications, and the surgeons will monitor your heart and lungs.

Outcome

The surgical site in your breastbone heals in 4-6 weeks.

To reduce the chance that your body will reject the donor organs, you will need to take immunosuppressive drugs for the rest of your life. Your doctors will only biopsy your new heart/lungs if you have signs of rejection. Additional drugs may be ordered to manage side effects. These drugs may increase your risk of developing cancer, kidney disease, and weak bones. You will have regular blood work and physical exams to monitor your heart and lungs.

About 60% of heart-lung transplant patients live more than one year after surgery. Most return to normal activities, including work and exercise. A specific rehabilitation program may be suggested to speed recovery and restore cardiovascular health. The transplanted heart responds slowly to increases in physical activity.

Call Your Doctor If Any of the Following Occurs

  • Signs of infection, including fever and chills—You are more susceptible to infections while taking immunosuppressive medications.
  • Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision site
  • Cough, shortness of breath, chest pain, or severe nausea or vomiting
  • Coughing up blood
  • Swelling of feet
  • Waking up at night feeling short of breath
  • Sudden headache or feeling faint
  • Sensation of your heart fluttering, missing beats, or beating erratically
  • Pain, burning, urgency, frequency of urination, or persistent bleeding in the urine

RESOURCES:

Scientific Registry of Transplant Recipients
http://www.ustransplant.org

Transplant Living
http://www.transplantliving.org

CANADIAN RESOURCES:

Heart and Stroke Foundation of Canada
http://ww2.heartandstroke.ca/Page.asp?PageID=24

University of Ottawa Heart Institute
http://www.ottawaheart.ca/UOHI/Welcome.do

References:

American Heart Association website. Available at: http://www.americanheart.org/presenter.jhtml?identifier=1200000 .

National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov/ .



Last reviewed November 2007 by J. Peter Oettgen, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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