According to World Heart Federation, heart failure affects more than 64 million (6.4 crore) people globally. Though there is no cure, advanced therapies like heart transplants may help people with end-stage heart failure by giving them a new lease of life.
Speaking to Happiest Health, Dr Khadijah Breathett, associate professor of medicine at Indiana University, Division of Cardiology, and advanced heart failure/transplant cardiologist at Indiana University Health, says about six and a half million (65 lakh) people are living with heart failure in the US. “About five-25 per cent of them probably have advanced heart failure and could be eligible for advanced heart failure therapy, which corresponds to about 3,25,000 transplants. However, we only do a little over 3,000 heart transplants a year,” she says.
Reasons for a heart transplant
Heart failure can be caused by coronary artery disease, high blood pressure or non-ischemic cardiomyopathy. The cause can be idiopathic (unknown cause), too, says Dr Breathett.
The potential recipient is evaluated for their eligibility to undergo the major procedure. Dr Thejaswi N Marla, cardiothoracic vascular surgeon, Fortis Malar Hospital, Chennai, says, “A complete evaluation is performed to see if the person can tolerate the procedure and if they can be discharged with the best outcomes. It includes full blood investigations, ultrasound of the abdomen, bronchoscopy and gastroscopy.”
Heart transplant criteria
Dr Breathett adds the criteria in the US essentially come down to three things — heart condition, whether the body is well enough to undergo the procedure and social support to help them get through the process.
She explains that the heart’s condition is determined by right-heart catheterisation, which shows if the heart requires advanced therapies like transplants or ventricular assist devices. A cardiopulmonary exercise stress test also helps to assess if the risk of loss of life within the next year is quite high.
What causes a heart transplant to fail?
A complete assessment of the following conditions is done so that there’s minimal risk for the heart transplant to fail, highlights Dr Khadijah.
- Functional capacities of other organs
- Risk of strokes
- Dementia
- Uncontrolled diabetes
- High BMI
- High and irreversible pulmonary hypertension
How does a heart transplant work?
The individuals whose lives are at higher risk make it to the top of the transplant list. Their listing statuses also depend on their blood type, weight and height. The match takes place after looking at different criteria, including the predicted heart mass of the donor.
Dr Marla shares that when there is a cadaver donor, hospitals with individuals on the transplant list are informed. “If the hospital mentioned first on the list gets the call and the organ matches the requirement, they go ahead. If they have logistics issues, they deny the organ and it then goes to the next person on the list. If the cadaver donor and recipient are in the same hospital, then they are given the first choice (I think it is better to keep this way as it is simpler to understand and has shorter sentences),” he reveals.
Moreover, the surgery needs to be conducted within four to six hours of the organ harvest as the organ undergoes some changes due to myocardial ischemia when there is no blood flow to and from the heart. The organ is stored in a solution called cardioplegia that prevents damage during transport.
What happens after the surgery?
The surgery can take four to eight hours, depending on the recipient’s condition.
Dr Marla explains that post-surgery, the person is kept under observation for about six days in the ICU and then for a few days in the ward before discharge. One might be able to leave the hospital after two weeks. However, the length of the hospital stay depends on the recipient’s condition.
In the post-operative period, a multidisciplinary team, including an advanced heart failure team, a cardiothoracic surgery team, an anesthesiology team and a critical care team, helps the recipient to recover. Dr Breathett adds that the recipient continues on immunosuppression therapies and medication during this time. This helps reduce the risk of infection, manage blood pressure, improve heart function and help them get off any life support like ventilators.
“Some tests are conducted periodically to ensure that the heart is functioning normally. It includes a biopsy to identify if there’s rejection. An echocardiogram is also routinely performed, even after they’ve left the hospital,” she says.
Rejection of a transplanted heart
The recipient is mobilized three to four days after the surgery. Complete recovery can take three to six months, but they need to constantly be on the lookout for cardinal symptoms like breathlessness, for organ rejection.
Despite appropriate therapies, recipients can reject the organ soon after the surgery, or even much later. It is called graft-versus-host disease (GvHD) and can be mild to severe. Dr Marla says though the risk is low, the body can reject the organ as it identifies the new heart as a foreign body.
Dr Breathett adds, “Depending on the level of rejection, recipients are treated by increasing their oral immunosuppression or IV medication such as steroids.”
Life expectancy after heart transplant
A Canadian entrepreneur, Harold Sokyrka (70), holds the Guinness World Record for being the longest heart transplant survivor. He had undergone the surgery 37 years ago in 1986.
Experts say that the survival rate in the first year is 90 per cent and recipients do well for a decade on an average. “In some rare cases, they may need another transplant — this is especially seen in those who had heart transplants as children. It could be due to cardiac allograft vasculopathy, where the blood vessels become smaller and more diseased, leading to the weakening of the heart. It can also lead to life-threatening arrhythmias,” says Dr Breathett.
The recipient should be on regular follow-ups after discharge. “The first follow-up happens in a week or 10 days’ time. After that, follow-ups usually are done once in three months for the first year of the surgery. Later, it is once in about six months,” says Dr Marla. However, they will be on immunosuppressants for life. They will also be more susceptible to infections. “Even a common cold in the family can affect them badly. So, they need to be very careful,” he adds.
Diet and exercises are important parts of the recuperation process. “People can start with low-intensity exercises probably after a month, and gradually increase the intensity after three to six months,” he says.
Takeaways
- A heart transplant is recommended for people with end-stage heart failure.
- A complete evaluation that includes blood workup, cardiac tests and functional capacities of other organs is done to check the eligibility of the person.
- The surgery can take four to eight hours, depending on the recipient’s condition.
- After surgery, one might get discharged in two weeks, depending on the medical condition.
- One must look for signs of organ rejection, which include regular cardinal symptoms like breathlessness.
- Proper diet, exercises and regular follow-ups can help improve the life span and quality of life of the recipient.
