Work-Up
Although you have been told that you need a heart
transplant to improve your condition, a final decision
cannot be made until extensive testing is done. Tests
to evaluate the condition of your heart, lungs, kidneys,
immune system and nutrition may discover that:
- continued
medical treatment would improve your condition
- a
surgical procedure other than a transplant would be
helpful
- a
condition exists that you are unaware of that would
make transplantation unsuccessful
Your
tests will be scheduled by the transplant team, and
most tests can be done as an outpatient. Detailed instructions
for each test will be given to you when they are scheduled.
The evaluation includes multiple blood samples, pulmonary
function tests, cardiac diagnostic testing, carotid
and lower extremity arterial Doppler, CT scan of chest
abdomen and pelvis and bone scan. When any of these
test results are abnormal, further testing will be necessary.
Making
the Decision
After your tests are completed, the doctors will
review the results and propose the best treatment for
you. If transplant is recommended, the risks and benefits
of transplantation will be discussed with you and your
family.
Waiting
Once
the decision has been made that you are an eligible
transplant candidate, your name will be placed on the
national waiting list managed by the United Network
for Organ Sharing. Waiting time for a suitable donor
can be weeks or as long as two years. Many factors influence
the actual waiting time, so it is difficult to predict
just how long you will wait for a transplant. The matching
of a donor heart is based on the following factors:
- blood
type of both the donor and recipient
- height
and weight of both the donor and recipient
- waiting
time of the potential recipient
- medical
condition of the potential recipient
You
will receive a pager (free of charge) to keep you in
touch with the Loyola team at all times. Special travel
arrangements may need to be made if you live a great
distance from Loyola University Medical Center.
Monthly
education classes are available for the transplant candidate
and their family to learn about the transplant process
and life after transplant.
Mechanical
Support
Mechanical
support may be needed to improve circulation and improve
a patient’s health while awaiting a transplant. Loyola
is among a handful of medical centers in the country
approved to use the latest mechanical heart pumps to
serve as a bridge to transplantation.
When
the heart could benefit from a small amount of pumping
support, an intra-aortic balloon pump (IABP) may be
used. The physician inserts the IABP into an artery
in the patient’s groin and feeds it through the artery
until it sits in the thoracic aorta and serves to lessen
the work load of the heart by inflating and deflating
in time with the heart’s contraction.
Some
patients may require more assistance. A left ventricular
assist device called the HeartMate may be used.The HeartMate
is surgically implanted in the upper quadrant of the
patient’s abdomen and takes over the work of the heart’s
left ventricle. A driveline is connected through an
opening in the patient’s abdomen to a battery pack.
Loyolawas one of 16 medical centers to begin investigating
the HeartMate in 1992, and in 1996 Loyola began testing
a more advanced version of the device called the vented
electric HeartMate.
For
patients whose heart has failed so drastically that
they cannot be supported any other way, the total artificial
heart provides the ultimate level of support. The patient’s
own heart is removed and replaced with the mechanical
heart. The heart is pumped by compressed air through
tubes that exit the patient’s abdomen and connect to
a computerized drive console.
- From
Jan. 1, 1988, to Aug. 31, 1990, Loyola implanted 19
Jarvik-7 total artificial hearts, and 17 of those
patients were subsequently transplanted with donor
hearts.
- From
July 1, 1994, to June 1, 2000, Loyola implanted the
CardioWest total artificial heart in 16 patients,
and 12 of those subsequently received donor hearts.
- From
Oct. 31, 1994 to April 2, 2002, Loyola implanted the
CardioWest total artificial heart in 19 patients,
and 14 of those subsequently received donor hearts
Transplantation
When
the Loyola Heart Transplant Team is notified of an available
organ, information about the medical condition and health
history of the donor organ are obtained. The surgeon
and transplant cardiologist will decide if the donor
heart is healthy. The procurement team (surgeon &
nurse) will travel to the donor hospital. If the donor
is deemed unsuitable for transplant, the surgery is
cancelled and you will continue to wait for a suitable
organ.
The
operation is performed by the heart transplant surgeon
and the surgical team. Surgery will take approximately
four to six hours.
Post-Operative
Recovery
After surgery you will recover
in the Surgical Intensive Care Unit. You will be on
the breathing machine (ventilator) until you are able
to breathe on your own. You will be transferred to the
Heart Transplant Unit once you are medically stable.
Long-Term Discharge
By
the third or fourth day after transplant, patients usually
can walk and begin regaining their strength. Some patients
can go home by the seventh or eighth day and continue
independent exercises at home. Some may need home visits
from a physical therapist to get back in condition.
Patients who have spent a long time in the hospital
and whose muscles are exceptionally weak may need a
longer rehabilitation period. Those patients may need
a short stay at a rehabilitation facility.
Long-Term
Management of Heart Transplantation
You and the transplant team
will work closely together to manage your long term
health. Now that you have received your new heart, you
will be responsible for lifetime management of your
diet, lifestyle, medical follow-up appointments and
testing and medications. Some activities must be done
daily such as taking your blood pressure, weight and
temperature to ensure your optimal health after transplantation.
Before
you are discharged from the hospital, you and your family
will receive instructions about your care at home for
life. After discharge from the hospital, you will be
seen by our transplant team weekly for two months, and
then every other week during the next two months. Due
to the frequency of these visits, you must reside in
the Chicagoland area after discharge from the hospital.
After returning to home, we will continue to manage
your heart transplant care, and you will need to return
to Loyola University Medical Center at least once a
month for heart biopsies and physician appointments
during the first year after heart transplantation.
Related
Links
Transplantation
Services
|
Clinical
Trials