Heart transplant surgery is nothing less than a boon for heart patients as it gives them new life. When a person’s heart becomes completely weak and does not get rest by any means of treatment, the surgery that is done is called a heart transplant. The primary benefit of a heart transplant is that many heart patients have got new life through it. But, what exactly actually happens in heart surgery? To solve all your queries, Onlymyhealth got in touch with Dr Santosh Kumar Dora, Senior Cardiologist, Asian Heart Institute, Mumbai talks about how to hear transplant works and one is one required. Read below to know all about heart transplant.
What is a heart transplant?
A heart transplant is a surgical procedure in which a healthy donor heart replaces a diseased, failing heart. The donor heart should be compatible with the recipient body concerning size and blood group. The donor’s heart is usually retrieved from a brain dead person after obtaining due consent from the relatives.
When is heart transplant an option?
Heart failure is the most typical reason for a heart transplant. Heart failure is a situation when a heart is not able to pump the blood as needed by body. Initially, heart failure can be managed by treating the aetiology, salt restriction, fluid restriction, and medications. In some cases, specialized pacemaker ( cardiac resynchronization therapy) helps improve heart pumping function. However, when heart failure persists despite all possible management options, then heart transplant is considered.
The other situations when heart transplant is considered are:
- Refractory ventricular arrhythmia despite medications, radiofrequency ablations when applicable or other forms of treatment
- Some congenital heart disease
- Coronary artery disease when medical, angioplasty and surgical options are exhausted or not feasible
- Valvular heart disease leading to dilated and failing heart when valve surgery carries a prohibitively high risk of mortality
- Failure of an already transplanted heart
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How is a heart transplant performed?
A heart transplant is 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's 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.
What is the apt age group for heart transplant?
Heart transplant benefits mostly young patients with age less than 60 yr. However, it can be performed in patients up to age 70 also in certain circumstances if a patient is physically fit and does not have other comorbidities. The surgical risk and transplant rejection rate become high in the elderly age group. Also, donor heart being a precious organ, it should be primarily reserved for younger and productive age group patients.
Patient stays for around 2 to 3 weeks in the hospital post-heart transplant surgery. Regular physiotherapy helps the patient recover quickly following surgery. Most patients should be fit to do daily activities within 2 to 3 months from surgery.
Medicine, food and exercise after transplant surgery
Medicines: The most important medicines are immunosuppressants to avoid rejection of the new heart. Maintenance immunosuppressant drugs generally consist of 3 drugs. Calcineuron inhibitor ( i.e tacrolimus), antiproliferative agent(i.e. mycophenolate mofetil) and steroid (i.e. prednisolone). Over time the dose of these drugs are reduced. They have to be taken timely and regularly at the proper dose—failing which, the new heart may get rejected. Various tests are done at proper intervals to know the blood levels and efficacy of drugs.
Food: Diet is essential for heart transplant patients. Diet should be meet all nutrition demands, and at the same time, it should be free from any microbes. Following is a brief guideline of diet for heart transplant patients.
- Do not take uncooked food as there is a risk of infection with raw food. Avoid salads, unpasteurised milk products, sushi etc. Peel off fruits nicely before consumption, as the peel may contain microbes. Do not take stale food.
- Avoid food with a high content of sodium and sugar. As you will be taking medicines like steroid, which itself can increase blood sugar level, avoid eating sugary diet. Immunosuppressant drugs can affect kidney and increase blood pressure, thus avoid taking excess salt.
- Abstain entirely from alcohol and smoking.
- Fats are equally essential for a health heart. One must know what should one eat to reap benefits of 'healthy fats'.
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Exercise: Following is a general guideline to exercise for heart transplant patients.
- Do warm-up before the exercise program.
- Dynamic exercises like walking, cycling will be good. Go to a level of exercise where you are comfortable, maintain it for several minutes to ensure good work out for your heart and other skeletal muscles.
- Cooldown over several minutes before stopping exercise
- Do not lift heavy weights more than 5 kg.
- Do not push or pull heavier weights( weight more than 5 kg)
- Do not do sit-ups, push-ups and pull-ups.
- Stop any activity which causes pain or pulling across your chests.
With inputs from Dr Santosh Kumar Dora, Senior Cardiologist, Asian Heart Institute, Mumbai
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