Heart Transplant Program

Heart failure is a condition in which the heart is weaker than normal and has difficulty pumping blood to the rest of the body. Over time, the weakened heart works harder and harder and adds more stress to the heart muscle walls, causing them to stretch and weaken even more. Fluid that cannot move forward out of the heart into the body backs up into the lungs, arms, legs, feet, abdomen and other parts of the body, causing congestive heart failure.

Unfortunately, the body responds to decreased blood flow by releasing substances (hormones) that cause salt and fluid retention and constriction of blood vessels. Thus, the body responds to congestion the same as it responds to dehydration.

Symptoms of heart failure vary depending on the condition of your heart. Your body responds to changes in your heart condition and often gives signals when major changes have occurred. You may experience some or all of these symptoms:

• sudden weight gain (two pounds overnight or three to four pounds in two days)
• swelling (edema) in your ankles, feet or legs
• swelling or bloating in the abdomen
• shortness of breath (may occur at rest, and usually worsens with activity)
• difficulty sleeping, especially when lying down
• frequent, dry, hacking cough
• loss of appetite or nausea, tiredness, weakness or confusion
• rapid or irregular heart rate

Heart failure is caused by many conditions that damage or weaken the heart muscle. Some of the most common causes of heart failure are:

• High blood pressure (hypertension): When blood pressure in the arteries is high, the heart has to pump harder to move blood out of the heart into the rest of the body. If the blood pressure remains high, the heart continues to work hard and becomes weak over time.
• Coronary artery disease: Coronary arteries provide blood supply to the heart muscle. Coronary artery disease is a build up of fatty deposits and plaque in the lining of the coronary artery that causes a decrease in blood flow to heart muscle. When a coronary artery suddenly becomes blocked, and blood flow to an area of heart muscle stops, it is called a heart attack. A heart attack can damage heart muscle and cause that area of the heart not to pump.
• Cardiomyopathy: Weakness or damage to the heart muscle can be caused by several things, including alcohol, infections, or drugs, but frequently the cause is unknown.
• Valve disease: When a heart valve leaks or blocks the normal flow of blood, the heart muscle pumps harder and may result in heart failure.
• Congenital heart disease: Heart defects that are present at birth

If following the transplant evaluation process, the heart transplant team and patient agree that transplantation is the best medical option, the candidate will be added to a national computerized waiting list.

The United Network for Organ Sharing (UNOS) is the national agency that oversees organ allocations, and LifeLink of Georgia is the recovery agency in this state. Generally, the organ should match the recipient's approximate size and blood group.

Many candidates can spend time waiting for a new heart at home. Some candidates may have to wait in the coronary care unit of a hospital because they are receiving intravenous medications under medical supervision or are on heart-assisting mechanical devices to help their hearts pump.

Priority on the waiting list is given to those candidates who are the sickest, have waited the longest and could benefit the most from a transplant.

The United Network for Organ Sharing (UNOS) provides a toll-free patient services line to help transplant candidates, recipients, and family members understand organ allocation practices and transplantation data. You may also call this number to discuss problems with your transplant center or the transplantation system in general. The toll-free patient services number is 1-888-894-6361.

Helpful ways of coping with the stress of waiting for a heart may include:

• Keeping up your normal daily routines as much as possible.
• Talking with someone on your team to help sort out your feelings. This could include your transplant coordinator, social worker, or physician. While waiting for a transplant, just "checking in" with your coordinator on a regular basis allows you to get questions answered and talk about any anxiety you may be having.
• Contacting the Georgia Transplant Foundation's Mentor Project. This program has been developed to match people who are new to the world of transplantation with people who are living with a transplant. You can get more information on the Mentor Project during your evaluation.

Orthotropic heart transplantation is the most common type of procedure performed. In this surgery, the diseased heart is removed and replaced entirely with the new donor heart. The donor heart is sutured (stitched) to remnants of the top two chambers of the native heart that are left in place for that purpose.

After arriving in the operating room, you will receive general anesthesia and be put to sleep. You will have a breathing tube (endotracheal tube) placed in your throat. This tube is connected to a machine called a ventilator, which will breathe for you during and after the operation. You will also be placed on a heart-lung bypass machine that will handle the functions of your heart and lungs while the surgeon is working on both your old and new hearts.

The surgeon will make an incision through your breastbone, called the sternum. When the new heart arrives, the surgeon will remove your heart, leaving only portions of the right atrium. The aorta, pulmonary artery and right and left atria from the new heart will be connected to the remaining portions of your old heart.

After surgery, you will go to the cardiac surgery intensive care unit (ICU), where a doctor and nurses are always very close by if you need anything. Initially, you will be under the effects of anesthesia. You will have many IVs, special tubes and a breathing tube. Once you wake up and breathe on your own, the breathing tube will be removed.

A typical stay in the ICU is three to four days. You will then be transferred to the cardiac surgery floor, where nurses and physical therapists will help you regain your strength, teach you how to care for yourself when you go home, and prepare you for discharge from the hospital. If all goes well, you can expect to spend three to four days on the cardiac surgery floor before your discharge.

While you are in the hospital recovering from your surgery, our pharmacists, coordinators and nurses will teach you and at least one family member about all your medications. We will review with you the purpose, dosage and possible side effects of each medicine. All transplant patients take immunosuppressants to help prevent rejection of their new organ.

Many patients will require additional medication for their blood pressure and to replace magnesium and phosphorus. Most patients also receive a stomach acid reducer, a cholesterol-lowering agent, and antibiotics. Other medications will be prescribed based on patients’ individual needs.

People who receive a heart transplant may develop complications after their surgery. The transplant team will help you understand the warning signs of possible complications, discuss your care, and recommend further treatment when necessary.

• Rejection is the most common complication following transplant surgery. It happens when the immune system, which defends the body against foreign agents such as viruses or bacteria, treats a transplanted organ as foreign and will try to attack it. To prevent your body from rejecting your new heart, you will take medications called immunosuppressants to suppress the immune response that rejects the foreign tissue.
• As a heart transplant recipient, you will be more susceptible to infection because you will take immunosuppressant medications to help prevent rejection. The risk of infection from bacteria and viruses is greatest in the early period after transplant, when dosages of medicines are at their highest.
• Many transplant recipients take medications to control hypertension, since prednisone and cyclosporine, two of the medications used to limit rejection, can raise blood pressure.
• Some of the medications patients are required to take after transplant to prevent rejection can have an adverse effect of the kidney's filtering function. The transplant team will use caution when considering the use of other drugs that can also be toxic to the kidneys, in light of the potential adverse effects of the transplant medications.
• Hyperlipidemia affects 60 to 80 percent of heart transplant recipients due to the effects of cyclosporine and Prograf. Patients are placed on a cholesterol-lowering medication immediately following transplant to reduce the risk of transplant coronary artery disease.
• In some cases, the arteries in the transplanted heart narrow over time, resulting in graft (transplant) coronary artery disease. This may be caused by a different type of rejection of the heart by the body's immune system.