Guide to Heart Transplantation

About Heart Transplant

Organ transplants offer individuals facing serious disability and death the opportunity to lead more fully-functioning lives. Over 19,000 organ transplants are performed in the United States each year. The kidney was the first organ to be successfully transplanted in humans. Today, transplantation is performed with kidneys, liver, the pancreas, lungs, the heart, intestines, bone marrow and bones, corneas, skin, saphenous veins, and valves of the heart.

Cardiac transplantation is the surgical placement of a healthy heart from a human donor into the body of a person whose own heart is badly diseased. The procedure is also referred to as orthotopic cardiac graft.

A heart transplant is performed when congestive heart failure or heart injury can't be treated by any other medical or surgical means. It's reserved for those individuals with a high risk of dying from heart disease within one or two years. Most patients who undergo a transplant have one of two problems. One is irreversible damage to the heart caused by coronary artery disease, commonly called "hardening of the arteries," and multiple heart attacks. The other problem is cardiomyopathy, or heart muscle disease. In this condition, the heart cannot contract normally because of damage to the muscle cells. It may have been caused by bacterial or viral infection or hereditary factors. Occasionally, heart transplants are performed on people with other forms of heart disease. These might include the effects of rheumatic fever or hypertension (high blood pressure), abnormalities in the heart valves that cause damage to the heart muscle, congenital heart defects, those structural abnormalities present at birth, or rare conditions like heart tumors.

Who is a Candidate

With recent advances in surgical techniques and improved medical management of organ rejection after transplantation, an increasing number of those with end-stage cardiac disease are appropriate candidates for heart transplantation. The major limiting factor today is the short supply of donor organs.

In general, transplant candidates must be under age 65 and suffering from end-stage heart disease, but be in relatively good health otherwise. There are four basic questions that must be answered by the patient, his or her family and the evaluating physicians:

  • Have all other treatment options been considered and tried or ruled out?
  • Is the patient likely to die without benefit of a heart transplant?
  • Is the patient in general good health without active infections nor other complicating illnesses?
  • Will the patient be able and committed to assuming and maintaining the lifestyle changes that transplantation demands?

Cardiac Diseases That May Lead to Transplantation

Heart transplants are reserved for patients with severe heart failure. A brief summary of some causes of heart failure follows. To learn more about a specific condition, click on the associated link. Patients who are too ill to qualify for a heart transplant may be eligible to receive a cardiac assist device, either as a support until they can receive a transplant, or as a destination therapy.

Congenital Heart Disease refers to disorders of the heart that are present at birth and that can affect adult patients in many ways. This term encompasses a range of cardiac defects, including atrial septal defect (miscommunication between the right and left atrium), ventricular septal defect (a hole in the muscle which separates the right and left ventricles), and pulmonary stenosis (a narrowing of the valve between the right ventricle and the pulmonary artery).

Cardiomyopathy or heart muscle disease affects approximately 500,000 new patients per year in the United States. This group of disorders directly damages the muscle, impairing its ability to pump blood to other parts of the body. There are two major categories of cardiomyopathy: primary cardiomyopathy, defined as changes in the structure or function of the heart muscle that cannot be attributed to a specific cause, and secondary, which is associated with disorders of the heart or other organs.

Congestive Heart Failure occurs when the heart is unable to maintain adequate circulation of blood in the tissues of the body or to pump out the venous blood returned to it. This weakening of the heart prevents it from circulating a sufficient quantity of oxygen to the body's tissues. Common symptoms associated with heart failure are fatigue, shortness of breath, joint swelling and weight gain.

Coronary Artery Disease is the number-one killer of men and women in the United States. Also known as coronary heart disease, this disorder involves the progressive narrowing of the arteries that nourish the heart muscle. Often this disease is asymptomatic, but if one or more of these arteries become severely narrowed angina may develop during exercise, stress, or other times when the heart muscle is not getting enough blood.

Valvular Disease in the heart is caused by a number of conditions including congenital defects, such as rheumatic fever, or rheumatic heart disease. In heart valve disease, problems arise when a valve fails to close properly (mitral valve prolapse) or open properly (valvular stenosis). In either case, the heart has to work harder to pump enough blood to the body, eventually leading to heart muscle damage. Congestive heart failure, syncope (fainting), and arrhythmias are common signs of valve disease.

Next Steps

If you have heart disease and need help, we’re here for you. To get started today, call (212) 305-7600 or use our appointment request form.

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