During Heart Transplant Surgery

During Surgery: Notification and Preparing for Surgery

Notification for Surgery

When we find a suitable donor for you, one of the members of the transplant team will notify you by telephone. It is important that you always leave a number where you can be reached if you are away from home. We would not like to have missed getting in touch with you if you were out of touch.

As a rule of thumb, we will always call your home first. We recommend you purchase a pager as a means of contacting you, otherwise, we will rely on your home, work, relative, or cell phone number as a means of contacting you when we get an offer for you.

Preparing for Surgery

Right before surgery, you will have blood drawn so that we have up-to-date information about the key components of your blood. You will also be asked to give us a urine specimen. In order to cut down on the possibility of infection, you will have your chest thoroughly washed with a special cleansing solution, and your chest may be shaved. Finally, you will receive medications that will help to relax you and begin to make you feel sleepy.

Heart Transplant Procedure

Heart transplants have been perfected over many years. The following is an example of what will happen:

When an organ that meets your requirements is located, you will be called into the hospital by the nurse coordinator. The transplant doctors will be checking the donor organ while you are being evaluated and started on medications in preparation for transplantation. If the donated organ is good, you will then be taken to the operating room, put to sleep with an anesthetic, and one of the transplant surgeons will begin the process of preparing the chest cavity for removal of your heart.

The surgeon will begin by exposing the chest cavity through a cut in the ribcage. The surgeon will then open the pericardium (a membrane that covers the entire heart) in order to remove your diseased heart. The back part of your own left atrium will be left in place, but the rest of the heart will be removed.

Your new heart will be carefully trimmed and sewn to fit the remaining parts of your old heart. This transplant method is called an "Orthotopic procedure". This is the most common method used to transplant hearts.

You will be given medications both before and during the operation to prevent you from rejecting the new heart. After the operation, you will be taken to a special unit and hospital floor for recovery. You will stay in the hospital until your doctor believes you are ready to go home. How long you stay in the hospital will depend on the following factors:

• Your health
• How well the new heart is working
• Your ability to learn to take care of your new heart transplant

What You Can Expect When You Wake Up

You will wake up in the intensive care unit (ICU) after surgery. Around you, you will have lots of machines, tubes and people. You will hear lots of beeps, bells, and talking. You will have a tube in your mouth and throat that helps you to breathe but keeps you from being able to talk. You cannot eat or drink anything while the tube is in your mouth. You will have intravenous lines in the veins of your arms and your neck that will give you fluid and medications. You will feel a tube (one or two) coming from your chest which is draining fluid that can collect there. A large dressing will be covering the wound on your chest from the surgery. You will notice wires on your chest which connect you to a monitor so that your nurse can see how your heart is working. You will have a catheter in your bladder to continuously empty it.

All of these tubes and wires make it difficult to move, but they are necessary right after surgery. We try to remove them as soon as possible, however, in order to cut down on the chance of infection. As a result, a lot of tubes will be removed within the first day or two days after surgery depending on your condition. You may also find that you are unable to move because of medications given to you during the surgery. Do not worry. The effects of the medications will wear off. In terms of pain, most transplant patients say that it is not as bad as they thought it would be.

Your Nurse

Among all of the people moving around you, there will be one nurse who is assigned just to you. All of the nurses are specially trained in the care of transplant patients so you will be in good hands. If you are worried about being unable to talk with the tube in your mouth, stop worrying. The nurses have lots of experience with that and will be able to meet all of your needs.

Medical Management in the ICU and Other Floors

In the ICU

While you are in the ICU, blood tests, EKGS, and chest x-rays will be done frequently to follow your progress. Some of the drugs you will be taking affect the blood components and we want them to remain in the normal range.

One of the most important blood specimens that will be taken daily measures the amount of Cyclosporine or FK506 (Prograf) in your blood. We use the results from this specimen to adjust your Cyclosporine or Prograf dosage.

Be sure that you do not take your morning dose of Cyclosporine or Prograf until after this specimen is drawn.

For reasons that will be explained later, if your level is drawn after your morning dose, the results will be useless to us and will throw off our adjustments.

From time to time you may be asked for stool, urine, or sputum specimens. The purpose of these is to check the function of your digestive tract, kidneys, and lungs and to check for infections.

You may be asked to test your urine for sugar if your Prednisone causes you to have a high blood sugar level. Your nurse will teach you how to do this test.

Medical Management on the Other Floors

Chest x-rays, EKGS, and blood specimens will still be done at intervals. You will also have Cyclosporine or Prograf blood levels drawn. Once you move out of the ICU to one of the floors, you must still be sure that you do not take your morning dose of immunosuppressant until after your blood is drawn.

Chest PT

Your nurse and the respiratory therapist may frequently do what they call "chest PT" on you. This involves placing you on your side and then clapping and vibrating their hands on your back. The sound can be very loud, but it does not hurt. What they are doing is loosening any mucus that may be in your lungs and airways so you can cough it up. This helps to cut down on the chance of you getting a lung infection.

Isolation

After surgery, you take medication to prevent rejection. A side effect of this medication is a lowering of your body's ability to fight off infections. To protect you from infections of other patients, staff, and visitors, you will be in a room by yourself during the first few days after surgery. All persons entering your room must wash their hands well; wear a mask and gloves.

After a week or ten days, you may be moved to another area of the hospital called the Cardiothoracic Unit next to the ICU. If you go outside your room, you will need to wear a mask and gloves to avoid picking up germs that could cause an infection. Please avoid any other patients who have infections.

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Source: USC Cardiothoracic Surgery

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