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What happens during a heart transplant?

You will be laying on your back on the operating table; your arms will be placed at your sides, padded and tucked in place after your chest has been cleansed with antiseptic solution. A Foley catheter will be inserted to drain your bladder during and after the operation. An incision will be made over your breastbone or sternum and the bone divided to allow access to all parts of the heart.

You will be connected to a heart-lung machine which will circulate and oxygenate your blood during the operation. The operation is carefully synchronized to the progress being made by the donor organ harvesting team. While you have been preparing for surgery, another group of surgeons has traveled, usually by jet, to the donor hospital where they remove your new heart, examine its health, and carefully pack it in a special cold fluid for transportation back to you in the OR. There is continuous communication between the harvest team and your transplant surgeon's team to coordinate your operation with the timing of your new heart's arrival.

When the timing is right, your surgeon will open the pericardium that surrounds your diseased heart. Your heart is removed from its connections to the great arteries, leaving in place the back parts of your right and left atria. Your new heart is carefully fitted and sewn to the remaining portions of your atria. This method is called an orthotropic procedure and is the most common method of heart transplantation. After your new heart is completely sewn in place and begins to function, you are removed from the heart-lung machine.

With the completion of the operative procedure, one or more tubes are placed in your chest to permit drainage of fluids that accumulate as you recover. Pacing wires are also brought out of your chest cavity through the skin's surface in case there is need for electrical pacing of your new heart. The sternum is brought together with stainless steel wires, and the fatty tissues and skin are closed with absorbable sutures. This ensures the best cosmetic results in healing and avoids the need for later suture removal.
Generally, heart transplantation follows this process:
  • The heart transplant surgery will be performed while you are asleep under general anesthesia. A tube will be inserted through your mouth into your lungs. The tube will be attached to a ventilator that will breathe for you during the procedure.
  • The anesthesiologist will continuously monitor your heart rate, blood pressure, and blood oxygen level during the surgery.
  • The skin over the surgical site will be cleansed with an antiseptic solution.
  • The physician will make an incision (cut) down the center of the chest from just below the Adam's apple to just above the navel.
  • The sternum (breastbone) will be divided in half with a special operating instrument. The physician will separate the two halves of the breastbone and spread them apart to expose the heart.
  • Tubes will be inserted into the chest so that the blood can be pumped through your body by a cardiopulmonary bypass machine (heart-lung machine).
  • Once the blood has been completely diverted into the cardiopulmonary bypass machine for pumping, the diseased heart will be removed.
  • The donor heart will be sewn into place. Once the new heart is in place, blood vessels will be connected.
  • When the transplant procedure has been completed, the blood circulating through the cardiopulmonary bypass machine will be allowed back into the heart and the tubes to the machine removed. The heart will be shocked with small paddles to restart the heartbeat.
  • Once your new heart begins to beat again, the physician will observe the heart to assess the function of the heart and to make sure there are no leaks where the blood vessels are connected.
  • Temporary wires for pacing may be inserted into the heart. These wires can be attached to a pacemaker and your heart can be paced, if needed, during the initial recovery period.
  • The sternum will be rejoined and sewn together with small wires.
  • The skin over the sternum will be sewn back together. The incision will be closed with sutures or surgical staples.
  • Tubes will be inserted into your chest to drain blood and other fluids from around the heart.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.