Surgery & Postoperative Care

The Heart Transplant Operation

An Illustration from The Columbia Presbyterian Guide to Surgery By Eric A. Rose, MD What can you expect before you go into surgery? What takes place in the operating room during your surgery? What awaits you as you regain consciousness after the transplant operation is over?

Even though the waiting period can be long and you have lots of time to anticipate your surgery, most patients report that they are never fully prepared when the day (or night) finally arrives. Because time is so critical when your organ does become available, you will be rushing to the hospital, then rushing to get prepared for surgery.

What to Expect Before Your Surgery

When you arrive at Columbia University Medical Center, proceed immediately to the Admitting Office on the first floor of the Milstein Hospital Building. They will be expecting you and will quickly take care of all the arrangements to get you admitted and on your way to surgery.

After you are finished with the admitting process, you will be seen by a physician from the cardiac transplant surgery service who will obtain your surgical consent form and run the necessary preoperative tests. After this, you will be in your own hospital room where family and friends may wait with you until it's time to go to the OR.

When you reach the operating room, there will already be a bustle of activity. The nurses and surgeons, under the direction of your transplant surgeon, will prepare you for surgery. In preparation for your surgery and to reduce the possibility of infection, you will have your chest thoroughly washed with a special antiseptic cleaning solution, and your chest will be shaved. The anesthesiologist will attach heart and blood pressure monitors and begin to administer the anesthesia intravenously. At this point you lose consciousness and the operation begins.

What Happens in the Operating Room

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 cleansing your chest 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 from Columbia University Medical Center has traveled, usually by jet aircraft, 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 orthotopic 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.

What to Expect When You Awake

After surgery, you will regain consciousness in the Open Heart Recovery intensive care unit (ICU). Among all the people moving around you, there will be one nurse who is assigned to caring just for you. All the cardiac ICU nurses are specially trained to care for transplant patients and you are in expert hands. While you are in the ICU, blood tests, EKGs, and chest X-rays will be done frequently to follow your progress. Some of the drugs you will be taking affect the blood's components and we want to be sure they remain in the normal range. One of the most important blood specimens taken daily will measure the amount of cyclosporine in your blood. We monitor this carefully to adjust your cyclosporine dosage to prevent organ rejection.

Your new heart will be supported with intravenous medications for about 1-2 days until it recovers from the "shock" of the transplant but you will immediately feel the difference a healthy heart makes. Because the immune system gets activated immediately when the heart is transplanted, you will begin taking medications to prevent rejection even in the hours before your transplant and immediately afterwards. A typical stay in the intensive care unit is 1-3 days and then you continue your post-operative care on a regular hospital floor. You can expect to be in the hospital 10-14 days after your transplant.

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