The evaluation work-up includes a series of blood tests and tests to determine the condition of the heart, lung, liver and kidney systems. Potential transplant recipients are required to be substance-free at least a year before being listed for the transplant. Harmful habits such as smoking and alcohol or mind-altering drug dependency must be avoided.
Heart TransplantA heart transplant is the replacement of a patient's diseased heart with a healthy heart from a donor who has suffered brain death. The donor's heart is completely removed and quickly transported to the operating theatre. During the operation, the patient is placed on a heart-lung machine which pumps blood throughout the rest of the body. The patient's heart is removed, leaving the back walls of the heart's upper chambers. The back chambers on the new heart are opened and the heart is sewn into place. The blood vessels are then connected and blood flow through the heart and lungs is resumed. As the heart warms up, it begins beating.
Bridge-to Transplantation Mechanical CirculatorySupport therapies such as the Extra-Corporeal Membrane Oxygenator (ECMO) and the Ventricular Assist Devices help advanced heart failure patients survive and function till a donor heart is found. This is known as Bridge- to-Transplantation. (BTT)
The quality of life for patients improves dramatically after transplant and they are able to lead more active lifestyles. However, patients need to take medications such as immunosuppressant for life. The medications keep the body from rejecting the transplant. A patient’s survival depends on many factors, including age, general health and response to the transplant.
Our Transplant team will provide you with more advice and consultations after your transplant for a smooth recovery journey.
1. What happens to patients referred for heart transplant?
- Due to the low donation rate, waitlisted patients with severely weakened heart, that medicines fail to maintain enough circulation, will be offered an option of Ventricular Assist Device (VAD) implant. The Left Ventricular Assist Device (LVAD) pumps blood from the left ventricle to the aorta. In some patients, a Right Ventricular Assist Device (RVAD) is needed to supplement the right ventricle. There are also Bi-Ventricular Assist Devices (biVAD) which assist both ventricles.
2. When does a patient need a VAD?
- Bridge to transplant - Patients who are already on the heart transplant list may deteriorate during their wait. For these patients, the heart pump assists their failing heart, supporting them until a donor heart becomes available.Bridge to recovery - There are conditions such as infections and alcool abuse that can lead to severe heart failure requiring placement of a VAD. In some instances, the heart recovers enough of its normal function after resting for some time and the device can be removed.
- Destination therapy - Also known as long-term or chronic therapy, destination therapy is used for patients who need a new heart, but are not eligible for transplant because of their advanced age or another disease or condition, such as cancer, which makes them unsuitable for heart transplant.VADs cannot be used for people with serious renal (kidney), liver or lung disease, blood clotting disorders, or infections that do not respond to antibiotics.
3. What happens during the VAD implant surgery?
- Implantation of a VAD involves open-heart surgery under general anesthesia. The heart will be stopped and the patient will be connected to a heart-lung machine, which will take over the pumping action of the heart and ensures the body continues to receive a flow of oxygen-rich blood.
During the surgery , the surgeon creates a pocket in the muscle under the heart. The main pump is tucked into this pocket. Tubes are then connected from the failing left ventricle to the pump and from the pump to the aorta. Once the device is activated, blood is pumped out of the left ventricle and injected into the aorta.
Read more about the Mechanical Heart Assist Device
The pump is also connected to a drive line, or cable, that exits the body through the right side of the abdomen. The drive line links to the computer that controls the pump and batteries that the patient must charge regularly.
The surgery lasts several hours and patients can expect to stay in the hospital for a few weeks. Recovery time from surgery depends on how healthy the patient was before the surgery. The patient and his caregivers will also learn how to manage and care for the VAD.
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