A new life with a new heart: Let's talk about heart transplant in simple terms

Has your heart become so weak that it can no longer be controlled by medication or other treatments? Sometimes the only and last option to save your life is to get a brand new, healthy heart. We call this a heart transplant. Since this is a very complex, major surgery, many people may have questions, fears, and curiosity about it. Therefore, today we will talk about everything from beginning to end, in a simple way that you can understand.

What is a heart transplant? Who needs it?

Simply put, a heart transplant is a surgical procedure in which your diseased, weakened heart is removed and replaced with a healthy heart from a deceased donor. This is a last resort treatment to save your life. That is, it is recommended for people with end-stage heart failure who cannot be cured by any other treatment.

There are many reasons why a heart can become so weak that it reaches this stage. The main conditions that require a heart transplant are:

• Cardiomyopathy: This refers to any condition that damages the heart muscle. It can be caused by a variety of factors, including infections and genetics. Sometimes, no matter how much testing is done, the cause may not be found.
• Coronary Artery Disease: A condition caused by blockage of the arteries that supply blood to the heart (coronary arteries). This can lead to heart attacks and irreversible damage to the heart.
• Congenital Heart Disease: This refers to defects in the structure of the heart that are present at birth. Some severe types of congenital heart disease may eventually require a heart transplant.
• Valvular Heart Disease: Diseases caused by damage to the valves in the heart.

This surgery can usually be performed on children as well as people up to 70 years of age, and in some special cases, up to 75 years of age.

How common are these surgeries? Why are they rare?

Heart transplants are actually one of the rarest surgeries in the world. There are two main reasons for that.

1. Shortage of donor hearts: In order for a heart to be transplanted, someone must donate it. There are very few such donors. Also, there must be a good match between the donor and the recipient. This means that both blood types must match, and the body size must be approximately the same. If this match is not perfect, the recipient's immune system is more likely to reject the new heart.

2. Complexity of the surgery: This is a very complex surgery that requires high technology and expertise. Therefore, this surgery can only be performed in hospitals that are specialized and have complete facilities for it.

What happens before surgery? Let's know exactly these steps

Once you've decided to have a heart transplant, you won't have to go through the surgery right away. There are several steps that need to be completed beforehand.

1. Referral to a transplant program: The doctor treating you will refer you to a specialized hospital that has a heart transplant program.

2. Checking whether you are suitable for surgery: Next, we will assess how well your body can withstand such a major surgery and whether you can achieve a good result after the surgery.

3. Waiting list: If it is determined that you are suitable for surgery, your name will be placed on a waiting list.

4. Treatment until a transplant is available: Until a suitable heart is available for you, various treatments are provided to keep your condition stable.

Let's look at this step in a little more detail.

Checking if you are suitable for surgery (Transplant Evaluation)

This is a very important step. Because there are a limited number of donor hearts, that precious organ is transplanted to someone who has the best chance of benefiting from the surgery, meaning living a long, good life. This involves looking at every aspect of your physical, mental, and social well-being.

Getting on the Waiting List

Once all of these tests confirm that you are suitable for surgery, you will be placed on a waiting list. People on this list receive hearts in order of priority. This means that the time you receive a heart depends on how urgent the need for a heart is.

Bridge Treatment

You may have to wait months, even years, for a suitable heart to be found. During this time, you will receive various treatments to support your weak heart and manage your symptoms.

• Medications: Various medications are given to speed up the heartbeat and help the heart pump.
• Mechanical devices: Sometimes special devices that help the heart pump need to be attached to the body. An example is an ``intra-aortic balloon pump''.
• Left Ventricular Assist Device (LVAD): If the heart is very weak and cannot pump enough blood to the body, this device is surgically implanted into the heart. This helps the heart pump blood.

How the surgery is performed step by step

As soon as you hear that you have received a matching heart, you will be immediately prepared for surgery. This is a very complex operation that takes many hours.

1. Anesthesia: First, you will be given general anesthesia to put you completely to sleep.

2. Connection to a ventilator: After you are asleep, a tube will be placed down your throat and connected to a breathing machine (ventilator). This machine will provide you with breathing throughout the surgery.

3. Connection to the heart-lung machine: Next, you will be connected to a cardiopulmonary bypass machine . Simply put, this machine temporarily takes over the work of your heart and lungs during surgery. It adds oxygen to the blood, removes carbon dioxide, and pumps blood throughout the body.

4. Removing the diseased heart: Surgeons will open your chest, close the blood vessels leading to the heart, and carefully remove your diseased heart.

5. Healthy heart transplant: Then, the healthy donated heart is brought to the site and connected to the main blood vessels. Then, the new heart is made to beat again. Sometimes, it also needs to be given a small electrical stimulation.

What to expect after surgery?

After the surgery is successfully completed, a new chapter in your life begins.

• Recovery in the hospital: You will need to stay in the hospital for about one to three weeks. The first few days will be spent in the intensive care unit (ICU) , where you will be monitored 24 hours a day, especially for signs that your body is rejecting the new heart.
• Home care plan: Before you leave the hospital, your doctor will give you a home care plan that will include everything from medications to eating, exercises to watching out for signs of infection or rejection.
• Cardiac Rehab: You will be placed on a special supervised exercise program to improve your strength, endurance, and heart function.

Immune System Suppression

This is the most important thing after surgery and something you need to do for the rest of your life .

Stop this denial, you will have to take special medications (immunosuppressants) that control or suppress the function of your immune system every day for the rest of your life .

What are the advantages and disadvantages of this surgery?

Advantages

The biggest advantage is that this surgery can save your life when there are no other options. It is the only solution when other treatments have not worked, are unlikely to help, or are too risky. Also, many people have the opportunity to live a better quality of life after surgery.

Disadvantages

• Due to the shortage of donor hearts, not everyone who needs a heart can get one.
• Because this is a very complex surgery, some patients' bodies may not be able to withstand the surgery.
• There are risks and potential complications associated with surgery.

Risks and complications associated with surgery

Like any major surgery, a heart transplant carries risks. Here are the main ones.

How long will it take to recover? What will the future hold?

It takes several months to fully recover. You will have to stay in the hospital for about 3 weeks. But with the advancement of modern medicine, the future for those who have had a heart transplant is very bright.

• The survival rate in the first year after surgery is more than 90%.
• About half of people live more than 10 years .
• With the advancement of medical science, there are now people who live healthy lives for 20-30 years or even longer .

That means you get a new opportunity to make lots of new memories with your loved ones.

Questions about daily life after surgery

When can normal activities resume?

Your doctor can give you the best advice on this. Generally, it is not recommended to drive or lift anything heavier than 5 kg for 6-8 weeks. It is very important to follow your doctor's instructions exactly.

Can I drink alcohol?

The best thing to do is to stop drinking alcohol completely or limit it greatly. Alcohol increases your blood fat levels (triglycerides). That's not good for your new heart. You've got a second chance at health, so it's your responsibility to take good care of that heart.

Can I get vaccines?

Yes, you can get many types of vaccines. However, some live vaccines cannot be given because you are taking medications that suppress your immune system. Therefore, it is essential to talk to your doctor and get his approval before getting any vaccine.

When you need to see a doctor or go to the hospital immediately

While you're at home after surgery, you should be very careful about certain symptoms. These could be signs of an infection or other serious problem.

• Fever.
• Pus or other fluid leaking from the surgical wound.
• Redness or a feeling of warmth around the wound.
• A feeling as if the middle bone in the chest (sternum) is moving or moving back and forth.
• Hearing or feeling a 'click' or 'click' sound in your chest bone when you move.

Don't ignore these symptoms. Getting treatment early can prevent major complications.