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Heart Transplant:
Understanding the procedure

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1.What is a heart transplant?

A heart transplant is a medical procedure that involves replacing a failing heart with a healthy heart from a donor. The process is seen as a last resort for treating heart conditions and is generally recommended by doctors when other treatments haven’t been fruitful. These treatments are surgeries, and they use medications to treat heart problems.

Heart failure is a condition where the heart is not working as efficiently as it usually should. Your entire body needs blood to perform all the necessary functions. When the blood flow becomes insufficient, due to the heart being unable to pump blood adequately, then disruption occurs; this makes your heart weak. Heart failure can affect any side of your heart, or it can affect both sides of your heart at the same time.

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2.Eligibility for a heart transplant

You need to meet the eligibility criteria before you can undergo heart transplant surgery. Not every individual who needs a heart transplant can get a heart transplant procedure done because in some cases, it can be dangerous. Several factors determine your eligibility, and your doctor will ensure you're eligible before you are recommended to get a heart transplant procedure.

The following are some factors that affect your eligibility for a heart transplant.

  • When you have an active infection then your doctor will not recommend heart transplant because it can cause more complications.
  • If you are not ready to take precautionary measures to ensure you keep your new heart healthy, your doctor won’t recommend the heart transplant procedure.
  • If your doctor thinks that recovering from a heart transplant surgery will be difficult for you then he may not recommend the procedure.
  • If someone in your family has cancer, or if there is a history of cancer, then you might not be a good candidate for a heart transplant procedure.
  • When you are suffering from another health issue that can potentially cut your life short, even after receiving a healthy heart, then your doctor won’t recommend a heart transplant.

The eligibility criteria for getting a heart transplant, will be determined by your doctor based on your current health, age, and lifestyle (among other factors).

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3.Understanding the heart transplant procedure

Understanding the heart transplant procedure

The heart transplant procedure is complex. It takes several hours for heart transplant surgery to be completed. If this is the second time that you're having heart surgery, then the heart transplant surgery can take longer than expected; the procedure is open-heart surgery. Firstly, you will receive general anaesthesia in the form of medication so that you sleep. Your body must receive oxygen-rich blood, which is why you will be connected to a heart-lung bypass machine.

Secondly, the surgeon will make an incision, and this allows them to operate on your heart. The incision will be made such that the chest bone is separated and the rib cage is opened. The surgeon then removes the diseased heart. The healthy donor heart is then sewn in place, and the blood vessels are then attached to the new heart. This process enables blood to start flowing, and the heart then starts to beat normally. If the donor's heart has trouble beating, then an electric shock might be given.

Once the heart transplant procedure is completed, you will receive pain relief medications. A ventilator will be used so that you don't have trouble breathing after heart surgery. Fluids need to be drained after the surgery, and this is done with the help of tubes that are attached to your heart and lungs. You will receive medicines and fluids through IV tubes once the surgery has been completed. You will stay in the ICU for a few days after the heart transplant surgery.

You will then be moved to a general hospital room where you can stay for a few weeks. Your stay in the ICU and hospital room depends on your situation and the surgery. Once you are discharged from the hospital, then you will be monitored frequently to ensure your health is as it should be. The monitoring is more frequent in the first few months, after your heart transplant surgery, and afterwards, the frequency decreases.

The tests include heart biopsies and electrocardiograms, among others. Heart biopsies are used to determine whether the new healthy donor heart is being rejected by your body or not. There is a higher chance in the beginning for your new heart to be rejected by your body, which is why heart biopsies occur more at that time. Mostly, there are no symptoms that give you an indication of your body rejecting the heart.

Some of the symptoms that can indicate donor heart rejection include unexplained weight gain, inability to breathe properly, fatigue, and not urinating as much as you normally do. These symptoms can indicate an infection, too, which is why you must contact your doctor whenever you experience something out of the ordinary.

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4.Finding a donor for heart transplant

Finding a donor for heart transplant

Firstly, you will be put on a waiting list after you are found to be eligible for a heart transplant. At the moment, there are thousands of people waiting for heart transplants because there are not enough hearts available. When you are waiting for a healthy donor heart to be available, your condition will be monitored by doctors. Your treatment can be changed depending on your condition when you are waiting for a heart to be available for transplantation surgery.

Some people develop severe medical conditions, where they may not be eligible for heart transplant surgery anymore. In this case, your name will be removed from the list until you recover from the health problem. Depending on your recovery, you may be put back on the waiting list for a donor's heart. When you are waiting, your doctors can recommend cardiac rehabilitation to you, which provides you with information about how to stay healthy before and after a heart transplant surgery.

When you are waiting for a donor's heart, sometimes your condition can deteriorate. This can be because the treatment that you are undergoing is unable to support your vital organs. This can cause health complications to arise. In such a case, you might need a device such as the ventricular assist device to be implanted. This helps to keep you stable until you receive a donor heart which can be transplanted in place of your diseased heart.

Once a donor's heart becomes available, several factors determine whether it is a good match or not. These factors include the duration you have for a donor's heart, the urgency of your request depending on the condition, and your blood type, among others. Only when the donor's heart makes a good match, your heart transplant procedure can be started.

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5.How to prepare for a heart transplant?

You can prepare for your heart transplant, depending on how long you need to wait for a donor's heart. You can start preparing for your surgery well in advance. This is best done by writing down any questions you may have and asking your doctor about them. For instance, you might want to know about the heart transplant cost, the duration of the procedure, and if there are any special arrangements that you need to make, in advance.

By asking questions, you will know how to prepare yourself, in the best way, for a heart transplant. This will help decrease stress because having a heart transplant can be quite stressful. Several tests will be done to ensure you are eligible for receiving a heart transplant. An evaluation will be done to ensure you are emotionally and physically ready to receive the donor’s heart. Your doctor will be best able to guide you about how you can best prepare for a heart transplant depending on your unique case.

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6.Risk and complications of heart transplant

A heart transplant procedure is a significant operation. Various risks and complications can arise due to heart transplant surgery. The following are some of the risks associated with heart transplant surgery.

There are various medications that you need to take after a heart transplant. These strong medicines can cause some side effects. For instance, immunosuppressants that you take after a heart transplant can cause health problems such as kidney damage. You can even get osteoporosis, diabetes, and high blood pressure as a result of taking these medications.

The body can reject the donor heart, which is one of the most significant risks of a heart transplant. About 10% of people who receive a heart transplant can show signs of heart rejection. This usually occurs in the first year after a donor's heart has been transplanted. The immune system is responsible for detecting any outside material. When a new heart is transplanted, your immune system can reject it as it starts to attack it, thinking that it does not belong in your body.

Generally, medications are given in the case of rejection. You don't need to experience any symptoms that indicate rejection. Doctors will monitor you and perform biopsies regularly, especially in the first year of heart transplantation. The biopsies are used to check the heart tissue, which is an indicator of whether the heart has been rejected or not.

Immunosuppressants lead to hampering your body's ability to defend itself against infection. Sometimes, there may be a need for the patient to be hospitalized due to a serious infection that is caused due to a heart transplant. When the immunosuppressant medicines are decreased after a while, then the risk decreases along with it too.

Coronary arteries can get affected after a heart transplant. Cardiac allograft vasculopathy, commonly known as CAV, can develop after a heart transplant procedure has been performed. In this condition, the walls of the coronary arteries become hard and thick. This leads to a problem in blood circulation which can eventually lead to other heart problems such as heart failure, heart attack, and abnormal heart rhythms. It can lead to death, as well.

Cancer is another risk of heart transplant surgery. It is recommended that regular checkups are done to ensure there is no cancer growth. Immunosuppressants are responsible for increasing the risk of developing cancer such as skin cancer, and non-Hodgkin's lymphoma after a heart transplant.

Some of the heart transplant complications include the formation of blood clots, heart stroke, bleeding, heart attack, and infection.

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7.How do I recover from a heart transplant?

Your doctor will provide you with thorough information about recovery after a heart transplant. You will need to ensure that you listen carefully to what your doctor says and follow the instructions so that you can recover well. People who receive heart transplants are usually able to lead better lives after the surgery and can go back to their usual activities. Recovery can take six months, but it can vary from person to person.

As long as you are taking the medicines prescribed by your doctor and taking good care of yourself, as per your doctor's recommendations, there is nothing for you to worry about. If you're a woman who has received a heart transplant and you are planning to have a baby, then you should speak to your doctor about it. Usually, women don't have a problem conceiving after a heart transplant, but the medications can cause complications.

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8.Precautions to take after surgery

Once the heart transplant surgery is completed, there are several precautions that you need to keep in mind. These adjustments might seem overwhelming, but they ensure that you can recover fast and can lead a normal life after a heart transplant.

Your doctor will prescribe immunosuppressants which are used to ensure your immune system does not attack the new healthy donor heart after it has been transplanted. Immunosuppressants ensure the risk of heart rejection is decreased. These are usually prescribed lifelong. Even with the help of immunosuppressants, your immune system might still not fully accept the new heart. The problem with immunosuppressants is there are many side effects, especially in the beginning.

Immunosuppressants can make you prone to infections because your immune system is suppressed and is not working optimally. For this, your doctor will prescribe additional medication. Sometimes, immunosuppressants can worsen some health issues, such as diabetes and high blood pressure. It can increase the risk of developing other health problems, like high cholesterol, as well.

The key to recovery, after a heart transplant surgery, is to ensure you listen to what your doctor advises. You need to make lifestyle changes so that you don’t develop any infections, in the future. You may need to include exercise and healthy eating habits in your routine.

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9.Life after a heart transplant

Life after a heart transplant

You will be constantly monitored after a heart transplant. In the first few months, many tests will be conducted to ensure the new heart has been accepted by your body, and to ensure additional problems won't crop up. You will need to ensure you are staying healthy at all times so that you can enjoy a good quality of life, after a heart transplant. Ensure you meet your doctor regularly and inform him about any problems you are experiencing.

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10.Diet and nutrition

Diet and nutrition are important aspects that you need to pay close attention to after you have a heart transplant surgery. You want to ensure you are taking care of your health and making healthy choices daily so that your heart remains healthy. Here are some diet and nutrition tips for a healthy heart.

  • You should drink plenty of water and stay hydrated at all times.
  • Ensure that you include lots of vegetables and fruits in your daily diet. Instead of only focusing on one type, you should have different types of fruits and vegetables daily.
  • You should consume lean meats such as poultry and fish, regularly.
  • If you drink alcohol then you should decrease how much you drink. However, it is best if you can avoid alcohol altogether.
  • Ensure you decrease salt consumption.
  • It is best if you opt for healthy alternatives such as whole-grain foods. These include whole-grain cereals, bread, and grains.
  • You should avoid grapefruit, including grapefruit juice.
  • You should ensure you are consuming sufficient calcium. You should choose fat-free dairy products or low-fat dairy alternatives.
  • You should take precautionary measures to ensure you don’t get any infection.

Your doctor will discuss healthy eating habits with you considering your current lifestyle and you both can create an eating plan accordingly. If you are obese, or overweight, then you should consider losing weight and maintaining a healthy weight with the help of exercise and diet. This will help ensure you can live healthily for a long time.

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11.Heart Transplant FAQs: All your concerns addressed

Q.   Can I continue to exercise after a heart transplant?

  1. Exercise is great for enhancing your overall health, and it is recommended by doctors after a heart transplant, as well. Regular exercise helps you reduce stress and control other conditions, so you can stay healthy; it helps you recover faster too so that you have strength. Not all types of exercises may be recommended though depending on your particular condition. You must consult with your doctor about the types of exercise that you can perform after a heart transplant.

Q.   What are the chances of survival after receiving a heart transplant?

  1. Survival rates, of people who have received a heart transplant, are high. With the right guidance and constant follow-up care, the chances of you surviving for five years, or more, after a heart transplant are high.

Q.   I have heart failure but I am managing it with medicine. How do I know when to consult my doctor, in case of an emergency?

  1. You must know when you should immediately call your doctor. When you notice that you are experiencing new symptoms then you should get in touch with your doctor as soon as possible. The following are a list of symptoms that indicate heart failure and you should call your doctor immediately.
  • You suddenly gain five pounds or more in a single well, or two pounds or more in a single day.
  • You find it difficult to breathe even when you are resting.
  • You experience chest pain.
  • You have an irregular heartbeat.
  • You don’t urinate like you normally do.
  • You notice your abdomen, feet, ankles or legs are swollen.
  • Your heart rate is rising to new levels.
  • You feel bloated all the time.
  • You feel very confused all of a sudden.
  • You feel more tired than usual.
  • You lose your appetite.
  • You are out of breath more often.
  • You have a tough time doing daily activity.
  • You notice a change in your sleep pattern; you may feel sleepier or have a difficult time sleeping.
  1. Whenever you experience something that doesn’t seem right, then it is best if you contact your doctor immediately. For this reason, you should always keep emergency contact numbers safely with you at all times, so you can easily access them whenever required.

Q.   What if a heart transplant is not possible? Is there an alternative?

  1. Some people are not good candidates for receiving a heart transplant. In such cases, doctors recommend ventricular assist device or VAD. These help pump blood and are implanted in your chest. They help to pump blood from your ventricles to your body. VADs can be used for short-term in some people or long-term in others. For instance, people awaiting heart transplant can have a VAD implanted until a donor heart is available.
  1. People who can’t have heart transplant can have a VAD implanted for the long term, as well.However, VAD isn’t for everyone. If your doctor notices that it is not helpful then an artificial heart is another option that your doctor can recommend.

Q.   I have just found out I need a heart transplant. I feel overwhelmed. What should I do?

  1. It is normal for you to feel overwhelmed with the news of requiring a heart transplant because things might not be the same after transplant. Instead of worrying about the heart transplant, it is recommended that you read as much as you can about heart transplant, so that you can have realistic expectations from the procedure. You can join a support group so you can gather information about people who have gone through the heart transplantation surgery.

Q.   Is there a chance of the new heart failing?

  1. Yes, there is. Not all heart transplants are successful and for some people, the new healthy heart might fail even after successful transplantation. Your body may reject the new heart completely even with the help of immunosuppressants or you might develop diseases such as coronary artery disease which can lead to heart failure. Your doctor will tell you about the best course of action, in each case.

Q.   Why choose Narayana Health for heart transplant procedure?

  1. If you are looking for one of the best heart transplant hospitals in India then Narayana Health is one of them. It is one of India’s leading heart transplant hospital which has top heart surgeons in India. It has an active transplant program available for patients and provides artificial hearts and ventricular assist devices for patients who are not eligible for a heart transplant as well. Narayana Health thoroughly evaluates you so you are always given the best treatment possible according to your case.
  1. Doctors at Narayana Health work with you so you understand the entire procedure and why you are being given the particular treatment for your heart condition. You will be guided by the doctors and they will leave no stone unturned to ensure that you are aware of what to expect before the procedure, during the procedure, and after the procedure. This helps you understand the entire treatment without feeling stressed at any point.

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