You will be taken on a stretcher to the operating room. You can expect the operating room to be brightly lit, cool and somewhat noisy, with a lot of people getting ready for the surgery.
You will recognize some familiar faces - the surgeons, the anesthesiologist, and maybe a few of the nurses.
The donor heart
A member of the transplant staff will go to evaluate the donor heart. Once the staff member has seen and determined the donor heart is satisfactory, he/she will contact your transplant surgeon.
At this time your surgeon will receive details on when the donor heart will arrive. We will then proceed with your surgery. Your family will be notified that the donor heart has been accepted and that surgery is proceeding.
Dry Run
There is always a possibility that the donor heart is not functioning properly or the donor may become too unstable to continue with transplant. The surgeon will inform you of this event as soon as they are aware of the situation. Please do not be too disappointed if this happens. We always have your best interest uppermost in our minds.
Anesthesia
The cardiothoracic anesthesia team will start to administer your general anesthesia through one of your IV lines. You will begin to feel sleepy and heavy. You will fall asleep quickly. Hearing will be the last sense to leave you before you go to sleep.
The cardiothoracic anesthesiology team will be using state-of-the-art equipment and safety features, including monitors that ensure you are safely anesthetized and asleep throughout your surgery. The team will constantly monitor your electrocardiogram, pulse rate, blood pressure, respiration and other vital body functions.
The Surgery
The surgeon will make an incision through your sternum (breast bone). You will be placed on a cardiopulmonary bypass machine that will mechanically take over the functions of the heart and lungs during the surgery.
The donor heart is removed by cutting the aorta and pulmonary artery in the mid sections. The atria are excised from the veins leading into the heart. When the donor heart arrives in the operating room, the surgeons will remove your heart and the donor heart will be placed in proper position. There are two methods by which this occurs.
Method 1 - Bi-atrial
The donor and recipient's left atria are connected. Then the right atria are connected. Finally, the aorta, pulmonary artery and pulmonary veins are sutured together.
Method 2 - Bi-caval
The donor and recipient's aorta, inferior and superior vena cava, pulmonary artery and pulmonary veins are sutured together.
The denervated heart
The donor heart comes with its own electrical system, the sinus node, and its own coronary artery supply.
However, when the heart is removed from the body, the nervous system is disconnected. The heart continues to beat adequately, but without the external nerve supply. This is referred to as a denervated heart. Small temporary pacemaker wires are attached to your new heart during surgery, and brought out through the skin near the base of the incision in case a temporary pacemaker is needed after surgery to assist the heart rate. If they are not needed, they will be removed after your first biopsy - usually within 7 days.
Surgery Time
The actual surgery may last from 4 to 12 hours, and sometimes longer. Each patient and each case is different. Please remember that if your surgery takes 8 hours and another patient's surgery only took 3 1/2 hours, it does not mean that you are doing worse than the other patient.