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A Tricky Part of Heart Transplant: Preparing for Surgery

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Posted: 3/17/2005

COLUMBUS, Ohio – Heart transplants tend to inspire awe – the removal and replacement of that core organ, and restarting a heart that has been on ice, remain difficult for many to conceptualize.

But the patients who have received heart transplants know that the surgery is one component of a long process of both staying healthy enough to endure the operation and doing the work required to enjoy recovery and the second chance at life.

“One of the most difficult issues, but also what is most likely to yield success in a heart transplant, is preparing the recipient for surgery,” said Dr. David Feldman, director of heart failure and cardiac transplantation at the Richard M. Ross Heart Hospital at Ohio State University. “Two things are particularly important: A patient who needs a new heart must not smoke. The second major effort is to ensure patients keep their weight down before the transplant.”

Being listed with the United Network for Organ Sharing as a potential recipient also kicks in an intense physical and psychological assessment of patients to ensure their condition cannot be treated in any other way and to evaluate the availability of appropriate support after surgery. “If indications are a patient is likely to live at least a decade with a new heart, he or she will be listed,” Feldman said. “That decision is never made on the basis of finances.”
The biggest challenge for patients after transplant, Feldman said, is adjusting to the immunosuppression medications required to prevent the body from rejecting the new heart.

“These drugs have changed significantly over the last 10 years. They’re more potent, but focused,” he said. “Patients who receive too much immunosuppression are prone to get cancer or have kidney problems. But if they don’t have enough, they’re at risk for cardiac rejection.”

Part of monitoring the patient for rejection after surgery is taking a weekly cardiac biopsy, and eventually tapering biopsies off to every six months. Additionally, Feldman says keys to long-term survival after transplantation include maintaining good relationships with doctors and staying compliant with the multiple required medications. Statistically, heart transplant patients are expected to live at least 12 years on average with their new hearts, meaning 50 percent of recipients live longer than 12 years.

“It becomes a matter of paying attention to the usual cardiac care,” Feldman said. “After all, after surgery, these patients no longer have a bad heart.”

Perhaps surprisingly, the number of heart transplants in the United States is on the decline after reaching a peak about 10 years ago, in large part because organ donation falls well below the demand nationally. But advances in medical research and device development already offer life-saving bridges to transplantation, and Feldman predicts that technology eventually will allow for creation of devices that will provide long-term alternatives to heart transplant surgery.

In particular, ventricular assist devices are mechanical pumps that help a damaged heart maintain necessarily blood flow. “The ventricular assist devices of the future will make the ones we use now look like dinosaurs,” he said. “Some patients may choose to never get a heart transplant because they’ll be so comfortable with ventricular assist devices.”


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Emily Caldwell
Medical Center Communications
614.293.3737
caldwell-6@medctr.osu.edu

Heart Disease; OSU Medical Center; Ross Heart Hospital; Transplant