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Heart transplant is a surgical procedure in which a diseased, failing heart is replaced by a normal donor heart. The donor heart should be compatible with the recipient body with respect to size and blood group. The donor's heart is usually retrieved from a braindead person after obtaining due consent from the relatives.
Heart failure is the commonest reason for a heart transplant. Heart failure is a situation when the heart is not able to pump blood as needed by the body. Initially, heart failure can be managed by treating the aetiology, salt restriction, fluid restriction, and medications. In some cases, specialized pacemakers (cardiac resynchronization therapy) help improve heart pumping function. However, when heart failure persists despite all possible management options then heart transplant is considered.
Heart transplant is a major surgery. When a donor's heart is available, the recipient is called to the hospital. Sometimes the recipient may be already admitted in the hospital and getting treatments for heart failure. The recipient is given medications to suppress his immunity so that he does not reject the donor heart. He is also given other medications like antibiotics. He is taken to the operation theatre and general anaesthesia is administered. He is put on a heart-lung machine. The diseased heart is removed, and in that place, the donor heart is placed and anastomosed to the resected parts. Surgery typically takes 5 to 6 hours.
A heart transplant is a complex heart surgery done on a very sick patient. There are several factors which determine the surgical outcome. After surgery, the patient remains in the ICU for several days. The patient is administered with high-intensity immunosuppressive therapy to prevent organ rejection. Slowly the hemodynamic support medicines are withdrawn and then the patient is ambulated.
Then the patient is kept in a reverse isolation room to prevent any kind of infection. People entering the room and involved in patient care are advised to strictly follow all aseptic measures. The patient is given several rounds of counselling by trained nurses, dietician, physiotherapist, psychiatrist to adopt a healthy lifestyle, transplant specific diet habits etc. The patient is counselled regarding periodic checks and uninterrupted drug therapy as it is very essential to avoid any kind of rejection. Typically, a patient is discharged in 2 to 3 weeks post-surgery.
Approximately 85 to 90% of heart transplant patients survive more than one year after surgery. The annual death rate is approximately 4% per year thereafter. The 5-year survival rate is approximately 70%. The most common deaths during the first year of surgery happen due to acute rejection or infection. Rejection episodes decrease after a year of surgery. The late deaths are due to several factors: infection, rapidly progressing coronary artery disease due to allograft vasculopathy, malignancy etc.
Young heart transplant patients survive better than older heart transplant patients. Studies have shown that patients 55 and younger had a 24 per cent greater chance of 10-year survival than older patients. Overall, 50% of patients having heart transplant have survived beyond 10 years. The one-year survival rate of children getting a heart transplant is 79%, and for 5 years is around 60%.
(Inputs by Dr Santosh Kumar Dora, Senior Cardiologist, Asian Heart Institute, Mumbai)
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