Things you need to know about Heart Transplant

Has your doctor talked to you about a 'heart transplant' because of a heart problem? Or have you heard about it but don't know exactly? It's normal to feel scared and curious about it because it's a very serious and complex surgery. So today, let's talk about what a heart transplant is and how to deal with it, simply and clearly.

What is a heart transplant, simply put?

Simply put, a heart transplant is the surgical removal of your diseased, malfunctioning heart and the replacement with a healthy heart from a donor. This is no ordinary surgery. It is the last resort for someone with end-stage heart failure who cannot be cured with any other medicine or treatment . However, since there are a limited number of donor hearts, you must meet certain strict criteria to qualify for this surgery.

Who needs a heart transplant?

This treatment is needed for people whose heart has been permanently damaged and is too weak to pump enough blood to meet the body's needs. There are several main conditions that can cause this.

Why is this surgery so rare?

Heart transplants are very rare. There are two main reasons for this:

• Donor shortage: There needs to be someone who can donate a healthy heart. Also, the donor and recipient must have a compatible blood type and be approximately the same size. If this "match" is not perfect, the body is more likely to reject the new heart.
• Complexity of the surgery: This is a very complex surgery. Only a few hospitals with special facilities and expertise can perform this surgery.

What happens before the surgery? (The Process)

This is not something that happens all at once. This is a long process.

1. Referral by your doctor: First, your treating doctor should refer you to a hospital that has a heart transplant program.

2. Evaluation: Next, you will be thoroughly examined to see how suitable you are for this surgery. This is because you need to make the most of the limited heart size. This evaluation includes several things:

• Medical tests: Blood, urine tests, kidney function, various infections (HIV, Hepatitis, Tuberculosis) are checked. Also, many tests are done such as X-rays, (CT) scans, (MRI), (Echocardiogram), (ECG). It is essential to completely abstain from alcohol, smoking (including vaping), and other drugs.
• Psychological and neurological tests: This surgery will be a big change in your life. Your ability to cope with it mentally and the support you receive from your family will also be assessed.
• Dental checkups: Don't be surprised, dental health has a big impact on the heart. Infections in the teeth can travel through the blood to the heart and cause damage.

3. Waiting List: If you pass all of these tests, you will be placed on a waiting list. Your place on this list will be determined by the severity of your condition.

4. Bridge Treatment: This is the name given to treatments that are given to manage your condition until a heart is available. This may be controlled with medication, or a machine that works to help the heart (such as a ``Left Ventricular Assist Device - LVAD'') may be temporarily connected to the body.

How the surgery is performed

Once you've been informed that a matching heart has been found, you'll be prepared for surgery. This is a complex process that can take several hours.

• First, you will be put under general anesthesia. This means you will be put into a deep sleep where you will not feel anything.
• Next, you will be connected to a machine called a ``ventilator'' to maintain your breathing.
• During the surgery, you will be connected to a special machine called a cardiopulmonary bypass machine to do the work of your heart and lungs. This machine is what keeps your blood circulating throughout your body.
• Then, surgeons carefully remove your diseased heart.
• Finally, the healthy donated heart is taken, connected to your main blood vessels, and put back into operation.

What happens after the surgery?

After surgery, you will need to stay in the hospital for about one to three weeks. For the first few days, you will be in the Intensive Care Unit (ICU), where you will be monitored 24 hours a day.

You may also be asked to join a cardiac rehabilitation program, which will help you gradually improve your strength and heart function.

Immune Suppression

This is the most important thing after surgery. Think of your body as a country. The immune system is the army of that country. Anything that comes from outside (viruses, bacteria) is seen by this army as an enemy and attacked. Since the new heart is also 'foreign' to the body, this army tries to attack it too. This is called "organ rejection" .

To prevent this, you will have to take immunosuppressants for the rest of your life. These medications work by reducing the power of that army and keeping the new heart from beating.

What are the risks of this surgery?

As with any major surgery, there are risks. The main ones are:

• Organ rejection of the new heart.
• Increased risk of infection due to medications that suppress immunity.
• Problems with the blood vessels in the transplanted heart (Cardiac allograft vasculopathy - CAV)
• Kidney disease.
• High blood pressure (Hypertension).
• Irregular heartbeat (Arrhythmias).
• Risk of cancer over time (due to immunosuppressive drugs).

Your doctor will discuss these risks with you in detail.

Symptoms that require immediate ETU (Emergency Treatment Unit)

If you see something like this while at home, immediately go to the nearest Emergency Department (ETU) or call 1990.

• Fever.
• Pus or fluid leaking from the surgical wound.
• Redness or warmth around the wound.
• A feeling that your breastbone (sternum) is moving, making a "clicking" sound when you move.

Heart Transplant, Heart Disease, Heart Disease, Surgery, Organ Transplant, Heart Failure, Heart Disease, Immunosuppressants, Cardiac Rehab, Sri Lanka