Heart transplantation is a lifesaving treatment option for patients facing end-stage congestive heart failure who have exhausted all other medical therapy, device treatment, or other surgical intervention options. Mount Sinai Heart at The Mount Sinai Hospital is one of only three heart transplant centers in New York City. Our cardiothoracic surgeons successfully perform approximately two-dozen heart transplants each year.
At Mount Sinai Heart, the heart transplant evaluation process starts with a comprehensive examination and evaluation by our transplant team, which consists in part of cardiologists, cardiovascular surgeons, transplant coordinators, nurse practitioners, nurses, social workers, nutritionists, physical therapists, pulmonary specialists, nephrologists, among other medical experts. Typically, transplant patients have a condition that cannot be fixed with medication or other surgeries, including:
- End stage heart disease that is life threatening
- Severe coronary artery disease
- Congenital heart defects
- Valvular defects
- Uncontrollable life-threatening irregular heart rhythms
After evaluation, we present your case to the Mount Sinai's Recipient Review Committee, and place you on a waiting list for a heart transplant. The United Network for Organ Sharing (UNOS), an independent, national organization, manages this list. There is a shortage of donors, so you may be on a transplant list for some time. In addition to the UNOS list, we also offer an alternate listing program that matches patients with an expanded donor pool. This program can help otherwise-healthy older patients who have been excluded from the standard national organ matching process.
What to Expect Before Surgery
Heart failure patients who receive a donor heart undergo open-heart surgery. Pre-surgery care includes:
- Physical exam
- Cardiac catheterization
- Echocardiogram to examine the size, shape, and motion of your heart
- Identify your blood and tissue type
- Tests to exclude diseases in other organ systems that may prevent you from receiving a transplant
- Discuss all medications you are taking, including over-the-counter drugs
The Transplant Procedure
This procedure typically takes eight hours during which you are under general anesthesia. During the transplant, we open your chest and connect you to a heart-lung machine, which takes over the functions of the heart and lungs during surgery. We remove your heart, sew the donor heart into place, and connect the blood vessels. Then, your blood will start to flow and warm the heart.
Your new heart may begin beating on its own, or it may need an electrical shock to get started. Typically, we attach a temporary pacemaker to the heart to help keep your heartbeat steady. When we are sure that your heart is beating fine, we disconnect the heart-lung machine, drain any blood that has collected in the chest cavity, and close your chest.
What to Expect After Surgery
Post-transplant, you stay in the cardiac intensive care unit, where we monitor your vital signs closely to ensure your new heart is functioning properly. You should not be surprised to find yourself connected to a variety of monitoring devices including a heart monitor, pacing wires, a breathing tube, and an intravenous line.
Most patients remain in the hospital for two weeks, however, you may need to stay longer due to complications, such as if you show signs of rejecting the new heart. People over 60 years old are at increased risk of complications, especially if you have another medical condition such as lung, kidney, or liver disease. During this time, we monitor you carefully, including taking biopsies of your heart.
While you are in the hospital, we will make sure that you:
- Breathe deeply and cough 10 to 20 times every hour.
- Take immunosuppressive drugs (likely for the rest of your life). These drugs reduce the chance that your body will reject the new heart.
- Work to prevent blood clots, such as wearing compression stockings
- Have blood tests
When you return home, you will need to follow-up to maintain your heart health. You will have periodic doctor appointments and biopsies so we can monitor your progress. You will also work with a physical therapist to increase your strength and endurance. Bear in mind that your new heart will respond slowly to increases in physical activity.
It is important for you to monitor your recovery after you leave the hospital. Alert your cardiologist to any problems right away, especially:
- Signs of infection, including fever and chills
- Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision site
- Changes in sensation, movement, or circulation in your arms or legs
- Changes in the location, type, or severity of pain
- Chest pain, pressure, or a return of your previous heart pain
- Fast or irregular heart rate
- Pain that does not improve
- Cough or shortness of breath
- Coughing up blood
- Severe nausea or vomiting
- Sudden headache or feeling faint
- Waking up at night due to shortness of breath
- Excessive tiredness, swelling of feet
- Pain, burning, urgency, frequency of urination, or persistent bleeding in the urine
Importance of Organ Donation
For healthy people, we cannot emphasize enough the importance of becoming an organ donor. There is a continuous shortage of donor organs, especially for heart transplants. Nearly 300 patients in the New York metropolitan area are awaiting heart transplant.