What to Expect: Heart Transplantation

Podcast Transcript

Announcer:

Welcome to Love Your Heart, brought to you by Cleveland Clinic's Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute. These podcasts will help you learn more about your heart, thoracic, and vascular systems, ways to stay healthy and information about diseases and treatment options. Enjoy.

Anthony Zaki, MD:

My name is Anthony Zaki. I'm a heart surgeon here at the Cleveland Clinic. One of my specialty areas is heart transplantation. Today my goal is to give you, the patient, an overview of what a heart transplant is and the general operating procedure.

The first thing to know if you're a patient with heart failure is that, for the most part, your condition can be managed with medications, procedures, or what we consider conventional cardiac surgery. However, if you're one of the patients that progresses to advanced end-stage heart failure, a heart transplant may be a great option for you. The first part of the procedure is determining if you are an eligible candidate. We have certain national criteria to determine if you are a transplant candidate. So you'll meet with a heart failure cardiologist, a transplant coordinator, a social worker, and one of the heart transplant surgeons like myself to determine if you are a good candidate for the procedure and if heart transplant is in your best interest.

Now, as a committee, we meet and we discuss your case and we determine if you are a good candidate for the procedure and what status to give you. There are six statuses that we assign patients. Status one is the highest priority. Those are our sickest patients that cannot wait much time before they receive a heart transplant. Now our lowest-status patients are status six. So once you're determined to be a good candidate, you're given your status and put on the waiting list.

The next part is to wait for an appropriate organ. When an appropriate organ becomes available, it is matched to you based on blood type, based on size, and other immune characteristics to prevent your body from rejecting the new organ. Our procurement team is sent out and they go and evaluate the heart and confirm that it's in good working condition, that there are no abnormalities and that is appropriate for transplantation.

Here on our end in Cleveland, you're brought into the hospital. You are prepared for the operating room and you wait for the heart to come. When the procurement surgeon takes the heart out of the donor, the heart can be preserved out of the body for up to four to six hours. We have several ways of preserving a heart. The classic way was in a cold solution in an ice box. However, in modern times, we have elegant new ways to preserve the heart on either a heart-lung machine, which can perfuse the heart with blood so that the heart is protected during travel. Again, once the heart reaches Cleveland Clinic, on our end, we are preparing you, the recipient, to be ready for the transplanted organ when it arrives.

Many of our patients with heart transplantation have had heart surgery before, whether they have a left ventricular assist device in place or whether they've had bypass or valve surgery in the past. So depending on your surgical history, the first part of the procedure is carefully entering the chest and exposing the heart. The next step is to support your body's circulation with the heart-lung machine. Once the donor heart is almost back to Cleveland, we begin by removing the old diseased heart. The heart is removed in a very specific way, preserving the five major connections that we will redo when the new heart becomes available. If an LVAD device is present, the LVAD is deactivated and removed fully. Once the heart has been fully removed, there are five major connections that we the transplant surgeons will redo when the new heart becomes available. For the short period that the heart is not in the body, your circulation and all of your body organs are being supported 100% by the heart-lung machine.

When the heart arrives, we begin implanting the new heart in a specific order. In general, we start with the connections that are furthest in the back and move from back to front. We use long suture to connect first the left atrium of the donor heart to the left atrial cuff in the back of the chest. After this, the remaining four connections are done in a similar manner using suture. Once we finish all five connections, an aortic cross-clamp is removed and blood flow is restored to the new heart. The new heart will beat spontaneously on its own as soon as blood is restored. Sometimes we have to add an electrical stimulation to give the heart a jumpstart. Once the five connections are done, we evaluate the heart and slowly wean or remove the heart-lung machine to see the heart beating on its own. We check for bleeding. We leave chest drains and then close your chest and you are sent into the ICU for closely monitored care.

After your heart transplant surgery, you'll spend a few days in our intensive care unit with our highly specialized transplant team. You'll be started on anti-rejection medications and be closely monitored. After that patients are transferred to our specialized transplant step-down unit where they spend the rest of their time recovering from their surgery until they're safe for discharge. Thank you for your attention, learning more about the heart transplant procedure, and we look forward to meeting you soon.

Announcer:

Thank you for listening. We hope you enjoyed the podcast. We welcome your comments and feedback. Please contact us at heart@ccf.org. Like what you heard? Subscribe wherever you get your podcasts or listen at clevelandclinic.org/loveyourheartpodcast.