1.Overstay more than package days, 2. Any other Specialty Consultations, 3. Special Equipment, 4. Additional Procedure/Surgery. 5. Blood Components.
What is Heart transplant?
A heart transplant is an operation in which a diseased, failing heart is replaced with a healthier donor heart. Heart transplant is a treatment that's usually reserved for people whose condition hasn't improved enough with medications or other surgeries.
Reason for Heart Transplant
A weakening of the heart muscle (cardiomyopathy)
Coronary artery disease
Heart valve disease
A heart problem you're born with (congenital heart defect)
Dangerous recurring abnormal heart rhythms (ventricular arrhythmias) not controlled by other treatments
Failure of a previous heart transplant
Who is a candidate for heart transplant?
You might not be a good candidate for a heart transplant if you:
Are at an advanced age that would interfere with the ability to recover from transplant surgery
Have another medical condition that could shorten your life, regardless of receiving a donor heart, such as a serious kidney, liver or lung disease
Have an active infection
Have a recent personal medical history of cancer
Are unwilling or unable to make lifestyle changes necessary to keep your donor heart healthy, such as not drinking alcohol or not smoking
Risks Involved in Surgery
Rejection of the donor heart. One of the most significant risks after a heart transplant is your body rejecting the donor heart. Your immune system may see your donor heart as a foreign object and try to reject it, which can damage the heart. Every heart transplant recipient receives medications to prevent rejection (immunosuppressant), and as a result, the rate of rejection continues to decrease. Sometimes, a change in medications will halt rejection if it occurs. Rejection often occurs without symptoms. To determine whether your body is rejecting the new heart, you'll have frequent heart biopsies during the first year after your
Primary graft failure. With this condition, the most frequent cause of death in the first few months after transplant, the donor heart doesn't function.
Problems with your arteries. This can make blood circulation through your heart difficult and can cause a heart attack, heart failure, heart arrhythmias or sudden cardiac death.
Medication side effects. The immunosuppressant you'll need to take for the rest of your life can cause serious kidney damage and other problems.
Cancer. Immunosuppressant can also increase your risk of developing cancer. Taking these medications can put you at a greater risk of skin and lip tumors and non-Hodgkin's lymphoma, among others.
Infection. Immunosuppressant decreases your ability to fight infection. Many people who have heart transplants have an infection that requires them to be admitted to the hospital in the first year after their transplant.
Preparations for a heart transplant often begin weeks or months before you receive a donor heart. If your doctor recommends a heart transplant, you'll likely be referred to a heart transplant center for evaluation or you can select a transplant center on your own. Once you decide on a center, you'll need to have an evaluation to see if you're eligible for a transplant. The evaluation will check to see if you:
Have a heart condition that would benefit from transplantation
Might benefit from other, less aggressive treatment options
Are healthy enough to undergo surgery and post-transplant treatments
Will agree to quit smoking, if you smoke
Are willing and able to follow the medical program outlined by the transplant team
Can emotionally handle the wait for a donor heart
Have a supportive network of family and friends to help you during this stressful time
Waiting for a donor organ
The wait can be long since there are more people who need hearts than donors and as per government regulations heart will allocate on first come first basis. Finding a donor depends on your size, your blood type and how sick you are. While you're on the waiting list, your medical team will monitor your heart and other organs and adjust your treatment as necessary. The team will help you learn to care for your heart by eating well and being active. If medical therapy fails to support your vital organs as you wait for a donor heart, your doctors might recommend that you have a device implanted to support your heart while you wait for a donor organ. These devices are known as ventricular assist devices (VADs).
Immediately before your transplant surgery
A heart transplant usually needs to occur within four hours of organ removal for the donor organ to remain usable. As a result, hearts are offered first to a transplant center close by and then to centers within certain distances of the donor hospital. The transplant center will provide you with a pager or cell phone to notify you when a potential heart is available. Once you're notified, you and your transplant team have limited time to accept the donation. You'll have to go to the transplant hospital immediately after being notified. Once you arrive at the hospital, your doctors and transplant team will conduct a final evaluation to determine if the donor heart is suitable for you and if you're ready for surgery. If your doctors and transplant team decide that either the donor heart or surgery isn't appropriate for you, you might not be able to have the transplant.
Heart transplant surgery is an open-heart procedure that takes several hours. If you've had previous heart surgeries, the surgery is more complicated and will take longer. You'll receive medication that causes you to sleep (general anesthetic) before the procedure. Your surgeons will connect you to a heart-lung bypass machine to keep oxygen-rich blood flowing throughout your body. Then surgeon will make an incision in your chest. Your surgeon will separate your chest bone and open your rib cage so that he or she can operate on your heart. Surgeon then removes the diseased heart and sews the donor heart into place. He or she then attaches the major blood vessels to the donor heart. The new heart often starts beating when blood flow is restored. Sometimes an electric shock is needed to make the donor heart beat properly. You'll be given medication to help with pain control after the surgery. You'll also have a ventilator to help you breathe and tubes in your chest to drain fluids from around your lungs and heart. After surgery, you'll also receive fluids and medications through intravenous (IV) tubes.
After the Procedure
You'll initially stay in the intensive care unit (ICU) for a few days, and then be moved to a regular hospital room. The amount of time spent in the ICU and in the hospital varies from person to person. After you leave the hospital, your transplant team will monitor you at your outpatient transplant center. Due to the frequency and intensity of the monitoring, many people stay close to the transplant center for the first three months. Afterward, the follow-up visits are less frequent, and it's easier to travel back and forth. You'll also be monitored for any signs or symptoms of rejection, such as shortness of breath, fever, fatigue, not urinating as much or weight gain. It's important to let your transplant team know if you notice any signs or symptoms of rejection or infection. To determine whether your body is rejecting the new heart, you'll have frequent heart biopsies. During a heart biopsy, a doctor inserts a tube into a vein in your neck or groin and directs it to your heart. The doctor runs a biopsy device through the tube to remove a tiny sample of heart tissue, which is examined in a lab.
You'll need to make several long-term adjustments after you have had your heart transplant. These include:
Taking immunosuppressant. These medications decrease the activity of your immune system to prevent it from attacking your donated heart. You'll take some of these medications for the rest of your life. Because immunosuppressant renders your body more vulnerable to infection, your doctor might also prescribe antibacterial, antiviral and antifungal medications. Over time, as the risk of rejection decreases, the doses and number of anti-rejection drugs can be reduced.
Managing medications, therapies and a lifelong care plan. Your doctor might give you instructions regarding your lifestyle, such as wearing sunscreen, not using tobacco products, exercising, eating a healthy diet and being careful to lower your risk of infection. Follow all of your doctor's instructions, see your doctor regularly for follow-up appointments, and let your doctor know if you have signs or symptoms of complications. It's a good idea to set up a daily routine for taking your medications so that you don't forget.
Cardiac rehabilitation. These programs incorporate exercise and education to help you improve your health and recover after a heart transplant. Cardiac rehabilitation, which you might start before you're released from the hospital.
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The amount of time for a heart transplant depends on the complexity of your case and if you need other procedures. If you do not have a VAD, surgery should take 3 or 4 hours. If you have a VAD surgeons needs to remove, or you've had prior chest surgeries, it should take 6 to 8 hours.
In a heart transplant procedure, a surgeon removes the diseased heart and sews the donor heart in place. He or she then attaches the major blood vessels to the donor heart. Most people who receive a heart transplant enjoy a good quality of life.
Recovery after your heart transplant is similar to the recovery after any heart surgery. It takes about six to eight weeks for your incisions to heal. At first, you may have some muscle or incision discomfort in your chest during activity. Itching, tightness, or numbness along your incision is also normal.
When a child receives a heart transplant, the transplanted heart grows to adult size as the patient grows. Your child will need to take immunosuppressive medications and other medicine for the rest of his or her life to control the side effects of the transplant.
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