Heart Transplant Program
Choosing the right hospital for a heart transplant is a decision that takes time and careful consideration. Cleveland Clinic Florida is here to make that decision-making process easier and more informative. Our Heart Transplant Program was developed in close collaboration with Cleveland Clinic of Ohio. As the top-ranked hospital in the nation for Heart and Vascular services for more than 20 years by US News & World Report Cleveland Clinic in Ohio has one of the largest heart transplant centers in the United States and has been performing heart transplants since 1984. Doctors are dually licensed to practice in both Ohio and Florida.
Cleveland Clinic Florida’s heart transplant team has decades of experience treating patients with heart failure and advanced heart disease. In addition to physicians and surgeons, the transplant team includes Transplant Coordinators, Social Workers, Pharmacists, Dieticians and Organ Procurement Specialists, many of whom have decades of experience in their areas of specialty.
As questions come up during the process of finding the right hospital for heart transplantation, we’ve made it as easy as possible by answering your most frequently asked questions. For more specific inquiries or to speak directly with a representative, please call us at 954.659.5133. Or you can reach us by email email@example.com.
Indications For Heart Transplant
What is Heart Failure?
Patients who are evaluated for a heart transplant have heart failure. Heart failure means that the heart muscle is weak and cannot pump, as it should. This causes less blood to be moved through the heart and body. The heart is not able to pump enough blood (rich in oxygen and nutrients) to meet the body’s needs. Often, the kidneys respond by causing the body to retain fluid and sodium (in that case, it can be called Congestive Heart Failure or CHF).
Causes of Heart Failure
Heart failure is caused by conditions that overwork the heart, such as:
- Coronary artery disease causing one or more heart attacks. A heart attack causes the heart muscle to be scarred and function inadequately.
- Cardiomyopathy, a condition that directly damages the heart muscle, causing the heart muscle to become weak.
Heart failure can be caused by other conditions that over work heart such as hypertension, valve disease, congenital heart defects and diabetes. Additionally heart failure can be caused by viral cardiomyopathy, drug-induced cardiomyopathy, chemotherapy and radiation.
Usually heart failure has been long-standing before the patient’s transplant evaluation, but sometimes the diagnosis is recent. . Before a patient is considered for a heart transplant, the doctor will work with them closely to treat the condition with medications, lifestyle changes and possibly surgery to make their heart work better.
Mechanical Circulatory Support Devices (MCSD)
For patients with end-stage heart failure, Mechanical Circulatory Support Devices (MCSD) are offered as treatment options available at Cleveland Clinic Florida. The left ventricular assist device (LVAD) is a type of mechanical circulatory device (MCSD) that is implanted in patients suffering from heart failure. The LVAD is used to assist the weakened left ventricle (major pumping chamber of the heart) pump blood throughout the body.
The LVAD offers two primary options available to the patient:
- Destination Therapy
Bridge-to-Transplant option is offered to patients who are awaiting a donor heart for transplant. Patients that are hospitalized with end-stage systolic heart failure and whose medical therapy has failed are usually the best candidates for this type of treatment.
Destination Therapy is the alternative option for patients who are not candidates for heart transplantation. This treatment option would provide long-term support for patients suffering from heart failure.
In addition to assisting a weakened left ventricle, LVAD will also provide blood pressure support as well as maintenance and improvement of organ function. The LVAD does not replace the heart, however it will allow the patient to be discharged from the hospital and allow for cardiac rehabilitation.
Heart Transplant: What To Expect?
Getting The Call
If a patient is approved to be placed on a waiting list for a heart transplant, he or she must wait for a donor to become available. If a heart becomes available and the patient is not in the hospital, they are immediately contacted by their Heart Transplant Coordinator. In some cases, the coordinator may arrange for transportation to Cleveland Clinic Florida or tell them to standby for further instructions.
It is imperative that the patient notifies the Transplant Coordinator if they update their contact information or address.
Once the patient is called, they cannot eat or drink anything and must keep their telephone line open. They should also bring a one-day supply of medications and their transplant notebook with them.
Arriving at Cleveland Clinic Florida
Upon arrival, the patient will be admitted to the Cardiothoracic Intensive Care Unit (CTICU) and a physical exam will be performed. A chest x-ray and blood tests will be performed. These tests are routine and help determine the patient's condition before surgery. The patient will be asked to sign consent for the surgery, blood products and solid organ transplant. They will be asked to remove dentures, contact lenses, make-up, and nail polish.
The Donor Heart
A team from the transplant staff will go to evaluate the donor heart. Once the team has seen and determined the donor heart is satisfactory, they will contact the transplant surgeon. At this time, the surgeon will receive details on when the donor heart will arrive. We will then proceed with the surgery.
Heart Transplant Surgery
Once the patient is in the operating suite, the actual heart transplant procedure can take anywhere from four to 12 hours or longer.
Because we only have a few hours to perform a transplant, we do a virtual crossmatch prior and actual crossmatch after the transplant. This involves comparing the blood of the patient and that of the donor. This test is helpful in the patient’s post-transplant care. It will help to determine their risk of rejection.
It is normal for the patient’s new heart to beat faster at rest. When the patient wakes up from the surgery, he or she will be in the Cardiothoracic Intensive Care Unit (CTICU). A team of specially trained physicians and nurses will monitor the patient’s care and help them recover safely and quickly.
Heart Transplant Evaluation
Anyone can contact Cleveland Clinic Florida’s transplant team to be evaluated for cardiac transplantation or other therapies for heart failure. Our coordinator will review the patient’s records and arrange a visit with one of the heart failure cardiologists. The evaluation by the heart failure cardiologist may take place in the hospital or in the outpatient clinic.
A multidisciplinary team of heart doctors, nurses, social workers, pharmacists and dieticians can review the patient’s medical history, diagnostic test results, social history and psychosocial evaluation results to see if the patient is able to survive the heart transplant procedure and comply with the continuous care needed to live a long healthy life.
The purpose of the evaluation is to determine the severity of the heart disease, and which form of therapy is best suited to for the condition. We do not recommend cardiac transplantation unless it is absolutely necessary, and likely to be associated with long-term success. Often times, other treatments are possible, including other surgical options.
A patient may undergo a variety of tests to determine the extent of their heart disease and what has caused it. If these tests have been performed recently, they may not need to be repeated.
An Electrocardiogram records the electrical activity of the heart. It documents abnormal heart rhythms, previous heart attacks, and thickening of the heart muscle.
The Chest X-Ray provides a picture on film of the structures in the chest. It helps to determine the size of a patient’s heart, status of the lungs and bony structures. It also determines whether fluid or congestion is present in the lungs.
A complete blood count, comprehensive metabolic profile, and protime INR are performed for the patient during the evaluation period. If further testing is indicated, then blood typing and tissue typing will be performed. We will also check previous exposure to hepatitis, HIV, and other infectious agents.
High frequency sound waves are used to provide pictures of the heart’s valves and heart chambers. It helps us to determine the size and function of a patient’s heart.
Pulmonary Function Test
A machine measures the rate and amount of air inhaled and exhaled through a mouthpiece. This test helps to evaluate lung function. Poor lung function would exclude a patient from cardiac transplantation, and dictate alternative therapies.
Post Transplant Discharge and Recovery
Most patients stay in the hospital 7-16 days after heart transplant surgery, but it’s important to remember that everyone recovers at a different pace. The transplant team will meet with the patient daily to update them about their progress and discharge plan. When the patient is discharged from the hospital, they will receive instructions about home care from the transplant team and nursing staff. It is important that they understand the treatment plan.
What do I need to do when I go home from the hospital?
Before a patient returns home, their doctor or nurse will explain everything they need to know about taking care of their wound and new heart. They must make sure that they understand their medications prior to leaving the hospital, as well as the signs and symptoms of infection and rejection.
Recovery From Heart Transplant Surgery
Recovery after heart transplant surgery is similar to any heart surgery. It takes about six to eight weeks for a patient’s incision to heal. In order to ensure proper healing, the following practices must be put into effect:
- Keep the incisions clean and dry
- Gentle soap and water should be used to cleanse the site
- Ointments, lotions or dressings must be avoided on the incision
- Must not drive a car for six weeks after surgery
- No heavy lifting of anything over 10-20 pounds for six weeks
- Must eat a healthy diet.
- Cedric Sheffield, MD
Director, Transplant Center
Surgical Director, Heart Failure, Heart Transplantation and Mechanical Circulatory Support
Cardiac Transplant Surgeon
- Viviana Navas, MD
Medical Director, Heart Failure, Heart Transplantation and Mechanical Circulatory Support
Heart Failure and Transplant Cardiologist
- Yordanka Reyna, MD
Heart Failure and Transplant Cardiologist
- Nicholas Smedira, MD
Thoracic and Cardiovascular Surgeon
- David Taylor, MD
Cardiac Transplant Surgeon
- Randall Starling, MD, MPH
Cardiac Transplant Surgeon
- Ahmad Zeeshan, MD
Cardiac Transplant Surgeon
Where does the donor heart come from?
The donor heart must come from someone who has been declared brain dead and whose family consents to donate their organs. It is an anonymous gift. Brain death is a permanent condition usually due to a head injury from a car accident, gunshot wound, or hemorrhage into the brain. It is diagnosed by many tests and confirmed by two physicians who are not involved with the donor’s care.
The donor’s heart continues to beat independently. Respirations are maintained by mechanical ventilation. The donor will also have an electrocardiogram, echocardiogram, and if necessary, a coronary angiogram to make sure the heart is suitable for transplant.
This information is then entered into the United Network of Organ Sharing (UNOS) computer and a list of suitable recipients is printed. The list is based on blood type, body size, UNOS status, and length of time on the waiting list. Race and gender of the donor has no bearing on the match.
What is rejection?
If the body recognizes the new heart as foreign, the immune system may try to to attack the transplanted heart. This is called rejection. Rejection must be detected and treated quickly to prevent damage to the transplanted heart. After a transplant, you are given the symptoms of rejection to look for and appointments are scheduled regularly with your doctor for checkups and myocardial biopsies.
What is a surgical site infection?
A surgical site infection is an infection that occurs after surgery in the part of the body where the surgery took place. Most patients who have surgery do not develop an infection. However, infections develop in about one to three of every 100 surgical patients.
How do you know if your incision is infected?
There will be increased drainage and or oozing from the incision. Redness will develop around the incision. An increase in body temperature and warmth along the incision line will start.
What is a dry run?
There is always a possibility the donor heart is not functioning properly or the donor may become too unstable to continue with the transplant procurement. This is considered a dry run. The heart surgeon will inform the patient immediately as they become aware of the situation.
What are immunosuppresant drugs?
Immunosuppressants are drugs that prevent the patient’s immune system from rejecting the new heart. They also place the patient at risk for infection. While in the hospital, the patient will begin to take steps to avoid infection. Many of these good habits will also help a patient prevent infection at home.
What can I eat after heart transplant surgery?
After surgery, many patients complain of a poor appetite and changes in how foods taste. Eating healthy foods is an important part of healing. Patients must try to eat smaller more frequent meals and choose cold foods. If patients need help with food choices, they can speak with our dietician.
Can you get coronary artery disease after a transplant?
Coronary artery disease after a transplant is sometimes called chronic rejection. It can occur any time after transplant, but most often several years after transplant. The coronary artery disease is different from the fatty or calcified plaque that occurs in non-transplanted hearts. After a transplant, you must follow a heart-healthy lifestyle to help lessen the risk of future coronary artery disease.
These heart transplant and heart transplant surgery resources are provided for your information only. Inclusion does not imply endorsement by Cleveland Clinic Florida. The heart transplant surgery information provided by these resources should not replace the advice of your healthcare providers.
Organizations Promoting Organ/Tissue Donation