What is heart transplant surgery?

A heart transplant is a procedure in which a surgeon removes a diseased heart and replaces it with a donor heart.

The doctor will make a cut (incision) in the skin over your breastbone (sternum). Then he or she will cut through your sternum to reach your heart. During the surgery, a mechanical pump circulates blood through the body while the doctor removes the diseased heart and replaces it with a healthy heart from someone who has died.

The doctor will use wire to put your sternum back together and will use stitches or staples to close the incisions in the skin over your sternum. The wire will stay in your chest. The incisions will leave scars that may become less noticeable with time.

You will spend about 1 to 2 weeks in the hospital after surgery. You may have to stay longer depending on your health and if you have problems from surgery.

You probably will feel better each day, but it may take several months to get your energy back.

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.

What happens before surgery?

Having surgery can be stressful. This information will help you understand what you can expect and how to safely prepare for surgery.

Preparing for surgery

• Bring a list of questions to ask your doctors. It is important that you understand exactly what surgery is planned, the risks, benefits, and other options before your surgery.
• Tell your doctors ALL the medicines and natural health products you take. Some of these can increase the risk of bleeding or interact with anesthesia. Your doctor will tell you which medicines to take or stop before your surgery.
• If you take blood thinners, such as warfarin (Coumadin), clopidogrel (Plavix), or aspirin, be sure to talk to your doctor. He or she will tell you if you should stop taking these medicines before your surgery. Make sure that you understand exactly what your doctor wants you to do.
• You may need to stop taking certain medicines a week or more before surgery, so talk to your doctor as soon as you can.
• Before your surgery, you will speak with an anesthesia provider to discuss your anesthetic options, including the risks, benefits, and alternatives to each. This may be on the phone or in person.

Taking care of yourself before surgery

• Stay as healthy as possible by eating a healthy diet and being as active as you can.
• If you have an advance care plan, let your doctor know. If you do not have one, you may want to prepare one so your doctor and loved ones know your health care wishes. Doctors recommend that everyone prepare these papers before surgery, regardless of the type of surgery or condition.

What happens on the day of surgery?

• Follow the instructions exactly about when to stop eating and drinking, or your surgery may be cancelled. If your doctor has instructed you to take your medicines on the day of surgery, please do so using only a sip of water.
• Take a bath or shower before you come in for your surgery. Do not apply lotions, perfumes, deodorants, or nail polish.
• Do NOT shave the surgical site yourself.
• Remove all jewellery, piercings, and contact lenses.
• Leave your valuables at home.

At the hospital or surgery centre

• Bring a picture ID.
• Before surgery you will be asked to repeat your full name, what surgery you are having, and what part of your body is being operated on. The area for surgery may be marked.
• A small tube (IV) will be placed in a vein, to give you fluids and medicine to help you relax. Because of the combination of medicines given to keep you comfortable, you may not remember much about the operating room.
• You will be kept comfortable and safe by your anesthesia provider. You will be asleep during the surgery. The surgery will take at least 4 hours.
• As you wake up in the recovery room, the nurse will check to be sure you are stable and comfortable. It is important for you to tell your doctor and nurse how you feel and ask questions about any concerns you may have.
• You will have a breathing tube down your throat. This is usually removed within 6 hours after surgery. You will not be able to talk or drink liquids while the tube is in your throat. After the tube is removed, your throat will feel dry and scratchy. Your nurse will tell you when it is safe to drink liquids again.
• You will have a thin plastic tube, called a catheter, in a vein in your neck. It is used to keep track of how well your heart is working. This is usually removed in 1 to 3 days.
• You will have chest tubes to drain fluid and blood after surgery. The fluid and extra blood are normal and usually last only a few days. The chest tubes are usually removed in 1 or 2 days.
• You will have several thin wires coming out of your chest near your incision. These wires can help keep your heartbeat steady after surgery. They will be removed before you go home.

Going home

• Be sure you have someone to drive you home.
• For your safety, you should not drive until you are no longer taking pain medicines and you can move and react easily.
• Arrange for extra help at home after surgery, especially if you live alone or provide care for another person.
• You will be given more specific instructions about recovering from your surgery, including activity and when you may return to work.
• You will likely start a cardiac rehabilitation (rehab) program in the hospital. You will continue with this rehab program after you go home to help you recover and prevent problems with your heart.

When should you call your doctor?

• You have questions or concerns.
• You don't understand how to prepare for your surgery.
• You become ill before the surgery (such as fever, flu, or a cold).
• You need to reschedule or have changed your mind about having the surgery.