HEART TRANSPLANTATION

What is a heart transplant?

A heart transplant, also known as a cardiac transplant, is a procedure where a heart that is irreversibly damaged and failing that is replaced by another heart procured from a suitable deceased donor.

A record 3,191 heart transplants were performed in 2016 in the US.

Who is an appropriate candidate for a heart transplant?

Any patient who has end stage congestive heart failure who has less than a year to live without a transplant is usually considered an optimal candidate for this procedure. In addition, these patients have not had any success with other medical or surgical treatment options for their heart failure.

What are some specific indications for heart transplantation?

These include:

Dilated cardiomyopathy

Ischemic cardiomyopathy

Conventionally untreatable congenital heart disease

Ejection fraction less than 20 %

Untreatable angina or cardiac arrhythmias

What workup is required for someone to get a heart transplant?

Routine tests like blood work and urine are performed in every patient.  Additional testing to look for specific viruses, fungal and TB infections, Pap smears in women and a PSA test for men are also performed. These tests are standard for almost every transplant candidate.

Specific testing on the heart such coronary arteriogram, echocardiogram, chest x-rays, maximal venous oxygen consumption, right and left heart catheterization and a measurement of the pulmonary vascular resistance are some tests that would determine if a patient would benefit from getting a heart transplant.

What is considered as a “bridge to transplantation”?

These are interim treatment options that support a candidate while he is waiting for a donor heart to become available. These include oral therapy and procedures done to artificially support the failing heart such as an intra-aortic balloon pump or implantable devices known as assist devices.

Who will not be a candidate for a heart transplant?

Usually patients who are older than 65 years old are evaluated on an individual basis to determine candidacy.  In patients with severe pulmonary hypertension, active severe infections or cancers, untreatable psychosocial issues such as substance abuse (tobacco, alcohol or drugs) or an inability to comply with medical follow-up are not considered candidates.

What are the outcomes of heart transplants?

Currently, 1 year survival rates are approximately 80 % or higher with almost 70 % patients alive after 5 years. It has been shown that in patients who have high blood pressure, diabetes or obesity (BMI > 35) have increased mortality.