During the procedure
Heart transplant surgery is an open heart surgery that takes several hours. If you've had previous heart surgeries, the surgery is more complicated and will take longer. You'll receive medication that causes you to sleep (general anesthesia) before the procedure. Your surgeons will connect you to a heart-lung bypass machine to keep oxygen-rich blood flowing throughout your body.
In this procedure, your surgeon will make an incision in your chest. Your surgeon will separate your chest bone and open your rib cage so that he or she can operate on your heart.
Your surgeon then removes the diseased heart and sews the donor heart into place. He or she then attaches the major blood vessels to the donor heart. The new heart often starts beating when blood flow is restored. Sometimes an electric shock is needed to make the donor heart beat properly.
You'll be given medication to help with pain after the surgery. You'll also have a ventilator to help you breathe and tubes in your chest to drain fluids from around your lungs and heart. After surgery, you'll also receive fluids and medications through intravenous (IV) tubes.
After the procedure
After you've had surgery to place your donor heart, you'll stay in the intensive care unit (ICU). You'll generally be moved to a regular hospital room after a few days in the ICU, and you'll usually remain in the hospital for a week or two. The amount of time you'll spend in the ICU and in the hospital can vary.
After you leave the hospital, you'll be closely monitored at your outpatient transplant center by your transplant team. Due to the frequency and intensity of the monitoring, many people stay close by the transplant center for the first three months. Afterward, the follow-up visits are less frequent, and it's easier to travel back and forth for follow-up visits.
You'll also be monitored for any signs or symptoms of rejection, such as shortness of breath, fever, fatigue, not urinating as much or weight gain. It's important to let your transplant team know if you notice any signs or symptoms of rejection or infection.
After your heart transplant, you'll have several follow-up appointments at the transplant center. You'll have regular tests, including blood work, echocardiograms, electrocardiograms and heart biopsies.
To determine whether your body is rejecting the new heart, you'll have frequent heart biopsies in the first few months after heart transplantation, when rejection is most likely to occur. The frequency of necessary biopsies decreases over time.
During a heart biopsy, a doctor inserts a tube into a vein in your neck or groin and directs it to your heart. A doctor runs a biopsy device through the tube to remove a tiny sample of heart tissue, which is examined in a lab.
You'll need to make several long-term adjustments after you've had your heart transplant. These include:
Taking immunosuppressants. These medications decrease the activity of your immune system to prevent it from attacking your donated heart. Because your immune system will most likely never completely accept the new organ, you'll take some of these medications for the rest of your life.
Immunosuppressant medications may cause noticeable side effects. For example, when taking post-transplant drugs such as corticosteroids, your face may become round and full, and you may gain weight, develop acne or facial hair, or experience stomach problems. Some side effects of immunosuppressant drugs may be more noticeable when you first start the drugs, but they may decrease in severity over time.
Because immunosuppressants make your body more vulnerable to infection, your doctor may also prescribe antibacterial, antiviral and antifungal medications.
Some immunosuppressants could also worsen conditions — or raise your risk of developing conditions — such as high blood pressure, high cholesterol, cancer, osteoporosis or diabetes.
Over time as the risk of rejection is reduced, the doses and number of anti-rejection drugs can be reduced, but you'll need some immunosuppressant medications indefinitely.
Managing medications, therapies and a lifelong care plan. After a heart transplant, taking all your medications as your doctor instructs and following a lifelong care plan is important.
Your doctor may give you specific instructions regarding lifestyle guidelines, such as wearing sunscreen, not using tobacco products, exercising, eating a healthy diet and being careful to lower your risk of infection in daily life.
Follow all of your doctor's instructions, see your doctor regularly for follow-up appointments, and let your doctor know if you have any signs or symptoms of complications.
It's a good idea to set up a daily routine for taking your medications so that you won't forget. Keep a list of all your medications with you at all times in case you need emergency medical attention, and tell all your doctors what you take each time you're prescribed a new medicine.
Cardiac rehabilitation. Cardiac rehabilitation programs incorporate exercise and education to help you improve your health and recover after a heart transplant. Staff members trained in cardiac rehabilitation may help you adjust to healthy lifestyle changes — such as regular exercise and a heart-healthy diet — after your transplant.
Your transplant team may also suggest that you begin a cardiac rehabilitation program prior to your transplant to improve your health.
Emotional support. Your new medical therapies and the stress of having a heart transplant may make you feel overwhelmed. Many people who have had a heart transplant feel this way.
Talk to your doctor if you're feeling stressed or overwhelmed. Transplant centers often have support groups and other resources to help you manage your condition.