Heart-Lung Transplant
Heart-Lung Transplant
Definition
This is a surgery to remove a severely diseased and damaged heart and lungs. They are replaced with a healthy heart and lungs from a deceased donor.
| The Heart and Lungs |
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Reasons for Procedure
A heart-lung transplant is done if you have:
- An irreversible, life-threatening lung disease that affects the heart (but are in otherwise good health)—An example of this is severe pulmonary hypertension (an increase in blood pressure in the lung's blood vessels).
- Have undergone other treatments (eg, surgery, medicine) without success
Possible Complications
If you are planning to have a heart-lung transplant, your doctor will review a list of possible complications, which may include:
- Infection
- Rejection of the donor heart or lungs
- Coronary artery disease
- Pneumonia
- Blood clots
- Bleeding
- Decreased brain functioning
- Damage to other organs, like the kidneys
- Irregular heart rate
- Anesthesia-related problems
- Infection or cancer related to taking immunosuppressive medicines
- Death
Some factors that may increase the risk of complications include:
- Pre-existing heart or lung conditions
- Age: 60 or older
- Kidney or liver disease
- Uncontrolled diabetes
- Infection
- Stroke
- Smoking
- Continued substance abuse or alcohol abuse
- Poor circulation
- Autoimmune disease
Be sure to discuss these risks with your doctor before the procedure.
What to Expect
Prior to Procedure
There is a shortage of donors, so you may be on a transplant list for some time. You may need to carry a cell phone with you at all times. This is to allow the transplant team to reach you if organs become available.
Your doctor will monitor your health to make sure that you are ready for the transplant. Before the surgery, your doctor will likely do the following:
- Physical exam
- Blood tests—to make sure your liver and kidneys are functioning normally
- Identify your blood group
- Tissue typing
Leading up to the surgery:
-
Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to one week before the procedure, like:
- Anti-inflammatory drugs (eg, aspirin )
- Blood thinners, like clopidogrel (Plavix) or warfarin (Coumadin)
- Do not take over-the-counter medicine without checking with your doctor.
- Arrange for a ride to and from the hospital.
- Arrange for help at home after the surgery.
- Eat a light meal the night before the surgery. Do not eat or drink anything after midnight.
Anesthesia
General anesthesia
will be used. It will block any pain and keep you asleep through the surgery. It is given through an IV in your hand or arm.
Description of the Procedure
After you are asleep, the doctor will cut through the skin and breastbone. She will open the chest and connect you to a heart-lung machine. This machine takes over the functions of the heart and lungs during the surgery. The doctors will then remove the lungs and the heart. The donor lungs will be attached. Then, the doctor will sew the new heart into place. Next, the blood vessels will be connected. The blood will start to flow and warm the heart.
The new heart may begin beating on its own, or the doctor may give you an electrical shock to get the heart started. The doctor will make sure that there are no leaks and that the heart and lungs are working fine. After this, the heart-lung machine will be disconnected. Next, temporary tubes may be placed in the chest cavity to drain any blood that has collected. The breastbone will be wired together, and the chest will be closed.
Immediately After Procedure
You will be closely monitored in the intensive care unit (ICU) with the help of the following devices:
- Heart monitor
- Pacing wires used to help control heart rate
- Tubes connected to a machine that helps drain excess blood and air from the chest cavity
- Breathing tube, until you can breathe on your own
How Long Will It Take?
Several hours
How Much Will It Hurt?
You will have pain during the recovery process. Your doctor will give you pain medicine.
Average Hospital Stay
This surgery is done in a hospital setting. The usual length of stay is two weeks. Your doctor may choose to keep you longer if you shows signs of rejecting the new organs or have other problems.
Postoperative Care
At the Hospital
While you are recovering at the hospital, you will need to:
- Breathe deeply and cough 10-20 times every hour to help keep your lungs working well.
- Take immunosuppressive drugs—You will likely need to take these for the rest of your life. These drugs reduce the chance that your body will reject the new heart.
Your doctor may need to take a
biopsy
of your heart or lungs if you:
- Have persistent fever
- Have poor heart function
- Do not feel well
At Home
When you return home, do the following to help ensure a smooth recovery:
- Take medicines as directed.
- Work with a physical therapist. Keep in mind that your new heart will respond slowly to increases in physical activity.
- Ask your doctor about when it is safe to shower, bathe, or soak in water.
- Be sure to follow your doctor's instructions.
The surgical site in your breastbone heals in 4-6 weeks.
Call Your Doctor
After you leave the hospital, contact your doctor if any of the following occurs:
- Signs of infection, including fever and chills—You are at increased risk for infection because of the immunosuppressive drugs.
- Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision site
- Cough, shortness of breath, chest pain, or severe nausea or vomiting
- Increased sputum (phlegm) production
- Coughing up blood
- Waking up at night due to being short of breath
- Sudden headache or feeling faint
- Changes in weight or blood pressure
- Chest pain or sensation of your heart fluttering, missing beats, or beating erratically
- Pain, burning, urgency, frequency of urination, or persistent bleeding in the urine
- Excessive tiredness or swelling of feet
In case of an emergency, call for medical help right away.
RESOURCES
Scientific Registry of Transplant Recipients http://www.ustransplant.org/
Transplant Living http://www.transplantliving.org/
CANADIAN RESOURCES
Health Canada http://www.hc-sc.gc.ca/index%5Fe.html/
Heart and Stroke Foundation of Canada http://www.heartandstroke.ca/
References
Surgery and other medical procedures for heart failure. American Heart Association website. Available at: http://www.americanheart.org/presenter.jhtml?identifier=123 . Updated April 2009. Accessed September 4, 2009.
What is a lung transplant? National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov/ . Updated December 2008. Accessed September 4, 2009.
Revision Information
- Reviewer: Michael J. Fucci, DO
- Review Date: 11/2012 -
- Update Date: 11/26/2012 -
