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Recovery and Next Steps After Heart Transplant Surgery

Immediately After Surgery

Patients awaken and begin their recovery after heart transplant surgery in the cardiothoracic intensive care unit (CTICU). Patients will have:

  • intravenous lines in their arms to deliver fluid and medications
  • tubes coming from the chest to drain fluid
  • a catheter in the bladder to empty it
  • wires from the chest connected to a monitor that may be used if the new heart requires electrical pacing
  • a tube in the mouth and throat to help them breathe, but which prevents speaking, eating, or drinking
Man who received LVAD
Richard Stowe received a HeartMate II in 2006. He feels
completely normal and mobile, and has been able to
eliminate or reduce many of his heart medications.
Echocardiography in April 2009 revealed dramatic
improvement: his left ventricle is perfectly normal
in size, his ejection fraction has increased from 5-10%
to 40%, and the other chambers of his heart continue
to improve.

In most cases, these tubes will be removed after the first day, and most patients are able to leave the CTICU two to three days after surgery. Patients will have frequent blood tests, electrocardiogram tests (EKG), and chest x-rays in order to monitor their progress.

Among the many people providing care during this time are dedicated transplant nurses who are assigned to the care of just one heart transplant patient at a time.

Steps to Recovery

After leaving the CTICU, patients continue their recovery in a "step-down" room for one to two days, and after that, in a regular hospital room. Once there patients are encouraged to walk and participate in physical therapy. Exercise programs are tailored to each patient's needs and abilities, but in general include:

  • breathing exercises
  • leg and foot exercises
  • arm exercises
  • walking
  • bicycling

Patients make the transition from a diet of clear liquids to full liquids, and then solid foods as soon as they are able.

On average, heart transplant patients leave the hospital about 14-21 days after surgery.

Long Term Care After Heart Transplantation

Patients who decide to undergo organ transplantation have a responsibility to care for and maintain their new heart and overall health for the rest of their lives. After transplantation patients must be conscientious about adhering to their medication regimens and their medical team's recommendations regarding diet, exercise, and lifestyle. Once at home, patients will need to monitor the vital signs and continue to take their medications as directed in order to prevent rejection of their new hearts.

Because there is an increased risk of infection from immunosuppressant medications, heart transplant patients must practice excellent hygiene, maintain good dental care, and be vigilant about exposure to infectious diseases. The transplant team provides thorough instructions about all of these issues, including skin care, and how to avoid infection.

Following up with the Medical Team

Patients will return to NewYork-Presbyterian for follow-up appointments weekly during the first month. During the second month, they will come every other week, and following that, once per month for ten months. At these visits, patients will have:

  • blood tests, which are timed to test the blood when the amount of immunosuppressant medication is at its lowest level
  • chest x-rays
  • electrocardiograms

Each year after transplantation, patients will return to the hospital for an annual examination and cardiac catheterization. The series of tests during this visit may take one or two days. Patients are also directed to call the clinic with any questions, if their health status changes, or if they experience any signs of infection.

Monitoring for Organ Rejection

If doctors suspect that a patient is developing signs of organ rejection they may perform an endomyocardial biopsy (heart biopsy or cardiac biopsy). During the biopsy they will remove a small piece of heart muscle for microscopic examination. The biopsy is performed through a catheter inserted through a vein in the neck or in the groin and advanced into the heart muscle. The procedure takes about a half hour.

If tests indicate signs of rejection, patients should be reassured that many people experience episodes of rejection, and such episodes do not indicate that they will lose their new heart. Very often, no symptoms are present, and adjusting the immunosuppressant medications resolves the problem.

Contact

NewYork-Presbyterian/
Columbia
Heart Failure and Transplantation Program
Directions
(212) 305-7600
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