Heart transplant question

  1. I couldn't decide where to post this question, so please do move it for me. Thank you.

    Can anyone please tell me the steps involved in the process of heart transplant when the family/patient has been told there is a heart available with your name on it? I mean, what happens next?
    And what happens the first post op day? And when do you expect the patient to wake up? AND (hopefully my last question) what signs of rejection might you see first?

    OK, this is a kind of personal question. I have a distant relative who has had the surgery and it got me thinking that I don't know much about the process. My experience has been in OB/Peds.

    I'm not looking for advice, just a little education beyond what I find on wikipedia. (even point me to good websites!)

    Thank you! KJ~~
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  2. 4 Comments

  3. by   core0
    Quote from KJRN79
    I couldn't decide where to post this question, so please do move it for me. Thank you.

    Can anyone please tell me the steps involved in the process of heart transplant when the family/patient has been told there is a heart available with your name on it? I mean, what happens next?
    And what happens the first post op day? And when do you expect the patient to wake up? AND (hopefully my last question) what signs of rejection might you see first?

    OK, this is a kind of personal question. I have a distant relative who has had the surgery and it got me thinking that I don't know much about the process. My experience has been in OB/Peds.

    I'm not looking for advice, just a little education beyond what I find on wikipedia. (even point me to good websites!)

    Thank you! KJ~~
    Basically once you are told there is a heart available you are admitted to the hospital. With the new rules most donations are going to either status Ia or Status Ib donors. They are usually in the hospital (at least in our OPO) or at home with an LVAD/BiVAD. There is usually a standard list of labs that are done if you come in from outside. They do a virtual crossmatch to determine the likelihood of type I rejection:
    UCLA Immunogenetics Center

    Once the virtual crossmatch is negative they send out a procurement team. Usually the recipient is taken to the OR and lines are placed before the procurement team gets there. Once the procurement team visualizes the heart the donor team will place the patient on bypass and remove the recipient heart. This happens pretty close to when the donor team arrives. The donor heart is then taken to the back table and the vessels are trimmed to size. If there are any anatomic variants such as a PFO this is taken care of then. The heart is then sewn into the recipient. Then the heart has to be restarted, the patient has to come off pump and the chest has to be closed. The whole process takes between 4-12 hours (sometimes more).

    Post op our patients come straight to CVICU. There are usually on the vent for a day or two. It depends on how well the heart is working. Some patients are extubated on post op day 1. Some need longer on the vent as the heart regains function. It is not unusual for the patient to come from the OR with four or more pressors and ionotropes. These all need to be weaned before the patient can go to the floor. I'm not sure how long they are on the floor since I'm not involved in that part.

    After transplant the patient has frequent heart biopsies to detect rejection. Otherwise rejection can resemble heart failure (shortness of breath, weight gain, fatigue etc).

    For a pretty good overview beyond wiki I recommend:
    Heart Transplantation: eMedicine Transplantation

    David Carpenter, PA-C
  4. by   highlandlass1592
    Just to add a bit to David's post. Our heart txp's may come back with an open chest incision....where they keep the mediastinum open to allow for coagulation correction and swelling reduction due to operative manipulation. These patients are then usually left on the vent over night and returned to the OR the next day for their incision to be closed. This is especially true with many of our VAD patients. This is a doctor preference issue but that is what is done at my facility.

    There are a lot of meds that are started and a TON of pt teaching that must take place before the pt can go home. As to inotropes, they can come out to our floor with them in place but they are at a lower dose than what is administered in the CVC-ICU. Chest tubes are usuallly able to be discontinued before the first biopsy is completed and pacing wires discontinued after the biopsy unless they are slower to recover. Incisions are watched like crazy to keep an eye out for infection. We also use tight glucose control in these patients and they are all at some point on prednisone which can make that a bit complicated.

    Just some random thoughts from my institution.
  5. by   highlandlass1592
    Quote from core0
    Basically once you are told there is a heart available you are admitted to the hospital. With the new rules most donations are going to either status Ia or Status Ib donors. They are usually in the hospital (at least in our OPO) or at home with an LVAD/BiVAD. There is usually a standard list of labs that are done if you come in from outside. They do a virtual crossmatch to determine the likelihood of type I rejection:
    UCLA Immunogenetics Center

    Once the virtual crossmatch is negative they send out a procurement team. Usually the recipient is taken to the OR and lines are placed before the procurement team gets there. Once the procurement team visualizes the heart the donor team will place the patient on bypass and remove the recipient heart. This happens pretty close to when the donor team arrives. The donor heart is then taken to the back table and the vessels are trimmed to size. If there are any anatomic variants such as a PFO this is taken care of then. The heart is then sewn into the recipient. Then the heart has to be restarted, the patient has to come off pump and the chest has to be closed. The whole process takes between 4-12 hours (sometimes more).

    Post op our patients come straight to CVICU. There are usually on the vent for a day or two. It depends on how well the heart is working. Some patients are extubated on post op day 1. Some need longer on the vent as the heart regains function. It is not unusual for the patient to come from the OR with four or more pressors and ionotropes. These all need to be weaned before the patient can go to the floor. I'm not sure how long they are on the floor since I'm not involved in that part.

    After transplant the patient has frequent heart biopsies to detect rejection. Otherwise rejection can resemble heart failure (shortness of breath, weight gain, fatigue etc).

    For a pretty good overview beyond wiki I recommend:
    Heart Transplantation: eMedicine Transplantation

    David Carpenter, PA-C
    Awesome post David!
  6. by   KJRN79
    Thank you, thank you, very informative. Now if anyone comes around asking ME any questions, I might sound like a know a little bit of what they are talking about. LOL. Very helpful. Thanks.
    My dad had CABG X 3 twice, one time another gentleman in the unit had his chest kept open for a day and then closed, so that part really made sense to my experience.
    :redpinkhe

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