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| Before Surgery Instructions: |
Before you can receive a transplant, you will first have to have a number of specific tests which will help doctors determine whether any other, less invasive treatment options exist for you, and to ensure that the rest of your body is healthy enough to support a transplant. Typical tests include a coronary angiogram (a dye test of the heart arteries), an echocardiogram (ultrasound of your heart), and a cardiopulmonary study of how your body uses oxygen. Different blood, urine, and x-ray tests will also be done to look for other medical problems that may make a transplant impossible; your kidney and liver functions are measured, the presence of infection (such as hepatitis) is determined, and finally doctors will also check your bone density.
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If, after the various tests, your doctors determine that a transplant is necessary, you will be put on a waiting list for a donor heart. When the transplant program notifies you that a heart is available, you need to arrive at the hospital within two hours of receiving the call. When you arrive, a team of doctors and nurses will prepare you for surgery. This includes a number of tests and procedures, such as measurement of your pulmonary artery pressures. |
You will have a pre-operative interview with an anesthesiologist who will ask you questions regarding your medical history. The transplant will be performed under general anesthesia, which means you will be asleep during your surgery. The anesthesiologist may also recommend the placement of an epidural catheter for the management of postoperative pain. |
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| After Surgery Instructions: |
Immediately after your transplant, while you recover in the hospital, frequent blood tests, including those measuring drug levels, electrolytes, and kidney function are performed. The transplant team will be watching for possible post-transplant complications, including infection and rejection of the heart. You will have several heart biopsies after the transplant so that your doctors can monitor for rejection. Heart biopsies involve inserting a tube holder into the vein in the neck or groin. Through this tube, the surgeon inserts an endoscope into the heart and small samples are taken. A pathologist reviews these to see whether your body is accepting the new heart. The frequency of biopsies depends on the time elapsed from transplant, your rejection history, and the protocols followed at your particular hospital. While you are still in the hospital, you will receive counseling from a dietitian, a physiotherapist, and a pharmacist to prepare you for your return home. It is important to have a friend or family member with you to help remember all of the information. Your doctor will give you contact numbers to call if you are having problems. |
If you recover smoothly and your body accepts the new heart, you should be able to go home from the hospital as soon as seven to twelve days after the operation. However, if there are complications such as infection or rejection, you will need to remain at the hospital for additional time. Following your transplant, you will need to take medications to suppress your immune system, so that your body will not reject your new heart. (You will need to take these medications for the rest of your life.) In addition, you will have regularly scheduled tests as an outpatient to monitor the function of your transplanted organ, and your doctors will encourage you to maintain a healthy lifestyle through diet and exercise. |
After you are discharged from the hospital, increase your activities slowly over the following six to eight weeks. Cardiac rehabilitation is an excellent way to get your full strength back; please ask your cardiologist what type of exercise program you should follow as you recover. You should watch for possible signs of infection, such as fever, sore throat, shortness of breath, cough, change in any mucus you cough up, cold sores, flu-like symptoms, or redness, swelling, or drainage from your incision. If any of these develop, you should contact your transplant center as soon as possible. Be careful handling animals, and do not clean litter boxes or bird cages, as these are risks of infection. If your body starts to reject the new heart, you may have shortness of breath, weight gain, fever, and fatigue. The only way to diagnose rejection is by heart biopsy. Again, contact your transplant center if these symptoms develop. We will follow up with you regularly to check on your progress. |
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