Heart Transplants By Emily Gorczynski

Anatomy and Physiology of the Heart

Image of a heart-lung bypass machine and how it works

When getting a heart transplant, the doctor will take the main arteries and veins and attach them to a heart-lung bypass machine. Once the destroyed heart is taken out and the new donor heart is in, the arteries and veins will be attached and your chest is closed. The arteries and veins will maintain their normal jobs, pumping blood and oxygen throughout the body, while the new heart is being placed in.


When this procedure would be required

Image of a heart transplant.

Individuals that end-stage heart failure, a condition when the heart is severely damaged or weakened.

May be caused by:

  1. Coronary heart disease (also called end-stage heart failure)
  2. Viral infections
  3. Hereditary conditions
  4. Heart attack (myocardial infarction or MI)
  5. High blood pressure
  6. Heart valve disease

What is wrong with the heart with end-stage heart failure?

The ventricles cannot fill or eject blood, specifically if the left ventricle ejection is less than 20%... normal is greater than 55%

How is homeostasis disrupted?

The body does not get the get the required amount of blood for the body to function properly, this causes leaks to occur and accumulate in your tissues and possibly lungs. The individual practically drowns to death in their own body.

Warning signs

The individual has..

  • Chest pain
  • Shortness of breath
  • Fainting or dizziness
  • Palpitations
  • Cough
  • Rapid weight gain
  • Swelling/pain in the abdomen
  • Swelling of the legs and ankles (fluid accumulation when blood begins leaking out of blood vessels)
  • Increasing fatigue
  • Awakening short of breath/ needing more pillows

Who can get end-stage heart failure?

  • Individuals over 75 years of age with especially those with high blood pressure
  • More common in women than in men
  • Commonly in African Americans than in Caucasions
  • About 5 million people in the United States have heart failure
  • Half of the 5 million pass away about 5 years after their diagnosis




Chest X - Ray

  • Helps with recognizing if there is a buildup of blood in the lungs
  • Could see if the heart is enlarged (what happens with end-stage heart failure)

Blood Tests

  • Low blood counts (anemia) = can cause symptoms like end-stage heart failure or contribute to this
  • Abnormal levels of Sodium, Potassium, Magnesium and other electrolyte levels
  • B-type natriuetic peptide (BNP) measured (hormone that increases by failing heart; increases when the heart failure worsens)

Echo-cardiogram (echo)

  • One of the most important tests in diagnosing patients
  • shows the beating of the heart and the functions (acts like an ultrasound)
  • Could help determine the cause of the failure and gives an accurate measurement of the left ventricle ejection percentage
  • Multiple-gated acquisition scanning (MUGA scan) -> mildly radioactive dye injected in the vein, travels to the heart and takes pictures of the right and left ventricles; pumping performance can be determined from this (not used very often)

MRI (magnetic resonance imaging)

  • magnetic fields provide pictures of the hearts structure to pump blood to the body
  • if Gadolinium used (special MRI contrast agent) can provide information about inflammation, injury and blood flow

tests to condition

Heart transplants are the only option when the heart can hardly pump blood and there is nothing to be done to repair the damage. This is also only used for patients that are not elderly and who do not have any other medical conditions that would disrupt the transplant. This will correct the condition because the patient will receive a completely new heart getting rid of the entire problem allowing for the body to go back to normal.

heart transplant: step by step process

After you have taken off all jewelry and changed into a hospital gown...

  1. An IV line will be in your arm
  2. catheters will be placed in blood vessels in your neck and wrist to monitor heart and blood pressure
  3. Foley catheter will be placed in bladder to drain urine
  4. Tube in your mouth or nose to your stomach to drain stomach fluids
  5. Chest hair may be shaved
  6. Placed under anesthesia and a breathing tube will be placed in your mouth to your lungs (attached to a ventilator that will breath for you during the surgery)
  7. Incision down the center of your chest from just below the Adam's apple to just above the navel
  8. The sternum will be cut in half and spread apart so they could reach your heart
  9. Tubes will be put into your chest so blood can be pumped through your body by a cardiopulmonary bypass machine while heart is stopped and replaced
  10. When all blood has been diverted into the bypass machine, the doctor will take out the heart
  11. The new heart is sewed into place and the doctor will connect the blood vessels carefully so there are no leaks
  12. After the heart is fully connected to blood vessels the blood circulating in the bypass machine is allowed into the heart and the tubes to the bypass machine are removed
  13. Surgeon will shock the heart with small paddles to restart the new heart
  14. Once beating the whole team will watch making sure it is beating properly and that there are no leaks
  15. Wires may be put into the heart and can be attacked to the pacemaker outside the body to pace the new heart if needed during the beginning of the recovery period
  16. Sternum is rejoined together and sewed together with small wires
  17. Skin over sternum sewed and they will use sutures or surgical staples to close the incision
  18. Tubes will be put in your chest to drain blood/ fluids from around the heart; they are connected to a suction device to drain fluids while it heals
  19. Lastly a sterile bandage/ dressing is applied

Brittney's Story of her transplant

Brittney, born October 26, 1990 had a rare life-threatening heart condition called hypoplastic left heart syndrome, the left side of her heart did not develop correctly and there is no cure and nothing to do. Doctors told her parents she only had a few days to live. Her parents did not give up and looked for answers, which her mom found in a People Magazine about a baby who received a heart transplant which was not very common then.

She was taken to Loma Linda University Medical Center in California. 26 days later a baby boy died in an accident and the parents "had the courage to see past their grief to donate his heart to me (Brittney)." Now, no one could tell she almost died and happens to be on the track and field team, not thinking much about her heartbeat. She competed in the Transplant Games all over the world and wins many medals and sent many of them to the family whose baby son died as a thank you for saving her life.

Brittney wants to become a psychologist to help families with the struggles that affect them every day.

She says, "Every time I take my transplant medication, I know I'm a little different - and a lot luckier - than many. I got a second chance, and I want to mean something. So when my friends are hanging out at the mall, my mom and I are often somewhere giving a presentation about the importance of organ donation...It's hard to believe that someone had to die in order for me to live. I think about that a lot. And I'm trying to make that gift mean something bigger. I hope I succeed."


Medications needed after heart transplant surgery:

Immunosuppressants -> decrease the activity of the immune system so it won't attack the new heart

Many times the immune system will never completely accept the donated heart, patients will be taking these for the rest of their lives

Immunosuppressants decrease the body's protection against infection so you may also get antibacertial, antiviral and antifungal medications

Lifestyle changes:

  • Wearing sunscreen
  • No tobacco products
  • Exercising
  • Healthy diet

The average life expectancy was 9.16 years after a heart transplant, but if the individual does what the doctor prescribes then they will live longer and healthier than what they would have had without a new heart.


fun facts

  • There are about 5,000 heart transplants preformed worldwide each year
  • There are about 2,000 heart transplants preformed in the United States
  • At any given time there are about 3,000 people waiting for a heart transplant

Leading medical centers for heart transplants:

  1. Aurora St. Luke's Medical Center (Milwaukee) - 7th largest robotic heart center in the world and a 1 month survival rate of 100%
  2. Duke Univeristy Hospital (Durham, N.C) - recognized by the HHS as the nation's largest heart transplant programs
  3. Indiana University Health Academic Health Center (Indianapolis) - full-service transplant center and have been preforming heart transplants since 1982
  4. Sutter Medical Center (Sacramento, California) - full-service cardiovascular center that had the first successful open-heart surgery, heart transplant, pediatric open-heart surgery and endoscopic vein harvesting procedure in Sacramento area
  5. Texas Heart Institute at Baylor St. Luke's Medical Center (Houston) - staff of 180 preformed more than 118,800 open heart operations, 258,000 cardiac catheterizations and 1,270 heart transplants


heart transplants over the decades

  • First human-to-human heart transplant was in 1967 but was not an option for end-stage heart failure until the 1980s when cyclosporin (CyA) was used, extending patient survival
  • Original technique was a biatrial technique
  • Began using immunosuppressions because before the patient would not live to long since the immune system would not accept the new heart

Biatrail Technique (original technique)

  • Left and Right Atria are preserved in the patient and moved to the corresponding atria of the donor
  • Sinoatrial Node is at risk of injury
  • Impacts atrial arrhythmias in postoperative period

Bicaval Technique (current one)

  • Right atrium is resected
  • Superior and inferior vena cavae are moved directly to corresponding donor structures
  • Removes the right atrial suture line
  • Preserves right atrial morphology
  • Sinoatrial Node and Tricuspid valve function is maintained


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Created with images by Dean McCoy Photography - "heart"

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