Heart Transplantation
Heart-and-lung transplant is surgery to replace a diseased heart and lungs with a healthy heart and lungs from a human donor.
Description
Heart-and-lung transplant operations have been performed since 1980 in the United States. Since 1995, between 30 and 70 heart-lung transplant are performed each year, according to the United Network for Organ Sharing (UNOS).
The donated heart and lungs are from a person who has been declared brain-dead, but remains on life-support. Tissue matching helps find the best match of donated organs to the patient.
While the patient is deep asleep with general anesthesia, a cut is made through the breast bone. A heart-lung bypass machine takes over the circulating of the blood, and maintains oxygen levels to the body.
The patient's heart and lungs are removed, and the donor heart and lungs are stitched into place. The heart-lung bypass machine is disconnected. The blood flows through the donor heart and air flows in and out of the donor lungs.
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Heart-lung transplant - series Illustrations:
Normal anatomy
The heart and lungs are located in the thorax, or chest cavity. The heart pumps blood from the body to the lungs, where the blood is oxygenated. It then returns the blood to the heart, which pumps the freshly oxygenated blood to the rest of the body.
Indications
A combined heart-lung transplant may be recommended for patients who have both cardiac and lung disease. The most common reasons for a combined heart-lung transplant are pulmonary hypertension, cystic fibrosis, lung disease associated with damage to the right ventricle of the heart, and various congenital defects of the heart and lungs.
Procedure, part 1
Heart-lung transplant operations have been performed since 1980 in the United States. The donated heart and lungs come from a human who has been declared brain-dead but remains on a life-support machine. A single recipient may receive one or both donor lungs. The tissues must be a match to help ensure that the patient does not reject the transplanted tissue. While the patient is deep asleep and pain-free (general anesthesia), an incision is made through the breast bone (sternum). Tubes are used to re-route the blood to a heart-lung bypass machine that keeps the blood oxygenated and circulating during the surgery.
Procedure, part 2
The patient's heart and lungs are removed and the donor heart and lungs are stitched into place. A heart-lung transplant is performed only in patients who have a very good chance of success. The long-term outcome is variable, depending on the patient's overall health and disease progression. Most patients should expect to stay in the hospital for an extended period of time. It generally takes about six months to fully recover from this surgery. To prevent rejection of the donor organs, the patient will likely take immunosuppressive medication for the rest of his life.
The external structures of the heart include the ventricles, atria, arteries and veins. Arteries carry blood away from the heart while veins carry blood into the heart. The vessels colored blue indicate the transport of blood with relatively low content of oxygen and high content of carbon dioxide. The vessels colored red indicate the transport of blood with relatively high content of oxygen and low content of carbon dioxide.
Indications
Heart-lung transplant may be recommended for patients with:
- Severely diseased lungs, such as with primary pulmonary hypertension
- Severely damaged heart
Risks
Risks for any anesthesia are:
- Reactions to medications
- Problems breathing
- Bleeding
- Infection
- Failure of the transplanted organs
- Rejection of the transplanted organs
- Infection due to anti-rejection (immunosuppression) medications
- Blood clots
- Stroke
A heart-and-lung transplant extends the life of a patient who would otherwise die. The operation is done only when there is a very good chance of success. While long-term outcomes are unknown at this time, 5-year survival is about 40 - 50%.
As with all major organ transplants, the problems are finding a donor, preventing rejection, and the cost of the surgery and medications.
Finding a donor for heart-lung transplant can be difficult. The donated organs must come from a person who has been declared brain-dead, but is still on life-support. The patient who needs the transplant must be healthy enough to survive the surgery.
Preventing rejection is an ongoing process. The body's immune system considers the transplanted organs as invaders, and fights them.
To prevent rejection, organ transplant patients must take anti-rejection drugs such as cyclosporine and corticosteroids that reduce the body's immune response. These drugs also reduce the body's natural ability to fight off various infections.
Informations obtained from National Institute of Health.