During the Procedure

Heart transplantation requires a stay in a hospital. Procedures may vary depending on your condition and your physician's practices.

Generally, heart transplantation follows this process:

  1. You will be asked to remove any jewelry or other objects that may interfere with the procedure.
  2. You will be asked to remove your clothing and will be given a gown to wear.
  3. An intravenous (IV) line will be started in your hand or arm prior to the procedure for injection of medication and to administer IV fluids, if needed. Additional catheters will be inserted in your neck and wrist to monitor the status of your heart and blood pressure, as well as for obtaining blood samples. Alternate sites for the additional catheters include the subclavian (under the collarbone) area and the groin.
  4. A catheter will be inserted into your bladder to drain urine.
  5. Heart transplant surgery will be performed while you are asleep under general anesthesia. A tube will be inserted through your mouth into your lungs. The tube will be attached to a ventilator that will breathe for you during the procedure.
  6. The anesthesiologist will continuously monitor your heart rate, blood pressure, and blood oxygen level during the surgery.
  7. The skin over the surgical site will be cleansed with an antiseptic solution.
  8. The physician will make an incision (cut) down the center of the chest from just below the Adam's apple to just above the navel.
  9. The sternum (breastbone) will be divided in half with a special operating instrument. The physician will separate the two halves of the breastbone and spread them apart to expose the heart.
  10. Tubes will be inserted into the chest so that the blood can be pumped through your body by a cardiopulmonary bypass machine (heart-lung machine).
  11. Once the blood has been completely diverted into the cardiopulmonary bypass machine for pumping, the diseased heart will be removed.
  12. The donor heart will be sewn into place. Once the new heart is in place, blood vessels will be connected.
  13. When the transplant procedure has been completed, the blood circulating through the cardiopulmonary bypass machine will be allowed back into the heart and the tubes to the machine removed. The heart will be shocked with small paddles to restart the heartbeat.
  14. Once your new heart begins to beat again, the physician will observe the heart to assess the function of the heart and to make sure there are no leaks where the blood vessels are connected.
  15. Temporary wires for pacing may be inserted into the heart. These wires can be attached to a pacemaker and your heart can be paced, if needed, during the initial recovery period.
  16. The sternum will be rejoined and sewn together with small wires.
  17. The skin over the sternum will be sewn back together. The incision will be closed with sutures or surgical staples.
  18. Tubes will be inserted into your chest to drain blood and other fluids from around the heart. These tubes will be connected to a suction device to drain fluids away from the heart.
  19. A sterile bandage/dressing will be applied.

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