33945 Heart transplant, with or without recipient cardiectomy

Name of the Procedure:

Heart Transplant, with or without Recipient Cardiectomy

Summary

A heart transplant involves replacing a diseased or failing heart with a healthy donor heart. In some cases, the recipient's original heart may be entirely removed (recipient cardiectomy) or left in place if compatible with the donor heart.

Purpose

Heart transplants are performed to treat severe heart failure or other heart conditions that can't be managed with medication or other surgeries. The goal is to extend and improve the quality of life for patients with end-stage heart disease.

Indications

• Severe heart failure not responsive to other treatments
• Congenital heart defects
• Life-threatening arrhythmias
• Cardiomyopathy
• Severe coronary artery disease

Candidates typically have a poor prognosis without transplantation and have undergone thorough evaluation.

Preparation

• Fasting for 6-8 hours prior to surgery
• Adjustments to current medications as advised by the doctor
• Blood tests, chest X-ray, echocardiogram, and other diagnostic assessments

Procedure Description

1. General anesthesia is administered.
2. An incision is made in the chest, and the patient is connected to a heart-lung bypass machine.
3. The failing heart is removed if recipient cardiectomy is performed.
4. The donor heart is placed in the chest and connected to the major blood vessels.
5. The heart-lung machine is disconnected, allowing the new heart to start beating.
6. The chest incision is closed.

Tools and technologies: Surgical instruments, heart-lung bypass machine, donor heart transport system.

Duration

The procedure typically takes 4-6 hours.

Setting

Performed in a hospital's cardiothoracic surgery operating room.

Personnel

• Cardiothoracic surgeons
• Anesthesiologists
• Surgical nurses
• Perfusionists (operating the heart-lung machine)

Risks and Complications

• Rejection of the donor heart
• Infection
• Bleeding
• Blood clots
• Complications from anesthesia
• Coronary artery disease in the transplanted heart

Complications are managed with medications, additional surgeries, or other medical interventions.

Benefits

• Extended lifespan
• Improved quality of life
• Enhanced ability to perform daily activities
• Decreased symptoms of heart failure

Benefits can begin to be realized within weeks to months post-transplant.

Recovery

• Hospital stay of 1-2 weeks, including time in the ICU
• Immunosuppressive medications to prevent rejection
• Regular follow-up appointments for monitoring
• Avoidance of strenuous activity for several months

Alternatives

• Ventricular assist devices (VADs)
• Medication management
• Other surgical interventions (e.g., coronary artery bypass surgery)

Alternatives may have limited long-term effectiveness compared to heart transplantation.

Patient Experience

Patients will be under general anesthesia and will not feel pain during the procedure. Post-surgery, they may experience discomfort and will have pain management options. Recovery involves close medical oversight, and patients can expect gradual improvements in their physical capabilities.