A heart transplant is a major surgical procedure performed when a person’s heart is severely diseased and no longer able to pump blood effectively enough to sustain life, and other medical treatments or surgeries have failed. This condition is known as end-stage heart failure.
End-Stage Heart Failure:
This is the primary reason for a heart transplant. It means your heart muscle is failing severely, and despite optimal medical therapy, you have:
- Severe symptoms: Shortness of breath, fatigue, fluid retention, even at rest or with minimal activity (often classified as New York Heart Association Class III or IV).
- Poor prognosis: A high risk of mortality within the next year without a transplant.
- No other effective treatment options: Medications, pacemakers, defibrillators, or other surgeries (like bypass or valve repair) are no longer sufficient to manage your condition.
Underlying Causes of End-Stage Heart Failure
- Cardiomyopathy: A weakening or thickening of the heart muscle, making it difficult to pump blood. This can be dilated (enlarged), hypertrophic (thickened), or restrictive (stiff).
- Severe Coronary Artery Disease (CAD): Blocked arteries that significantly reduce blood flow to the heart muscle, leading to severe damage and scarring (e.g., after multiple heart attacks) that can’t be fixed by revascularisation (stents or bypass surgery).
- Congenital Heart Defects: Heart problems that are present at birth and have progressed to end-stage failure despite previous repairs.
- Heart Valve Disease: Severely damaged or diseased heart valves that cannot be repaired or replaced by conventional surgery.
- Dangerous Recurring Abnormal Heart Rhythms (Ventricular Arrhythmias): Life-threatening arrhythmias that are not controlled by other treatments like medications, ablation, or implantable defibrillators.
- Failure of a Previous Heart Transplant: In some cases, a second transplant may be considered if the first donor heart fails.
Eligibility Criteria for Transplant
Even with end-stage heart failure, not everyone is a candidate for a heart transplant. A comprehensive evaluation by a transplant team is necessary to determine suitability. Key factors include:
- Overall Health: You must be healthy enough to undergo the major surgery and the rigorous post-transplant recovery and lifelong medication regimen. This means generally no other severe, irreversible medical conditions that would significantly shorten your life regardless of a new heart (e.g., active cancer, severe kidney, liver, or lung disease that isn’t manageable).
- No Active Infections: An active infection would be a contraindication until treated.
- Pulmonary Hypertension: Severe, irreversible high blood pressure in the lung arteries can make a heart-only transplant unsafe, as the new heart might not be able to overcome the high lung pressures.
- Commitment to Lifestyle Changes: This includes absolute abstinence from smoking, recreational drug use, and excessive alcohol consumption.
Alternatives While Awaiting Transplant or If Not a Candidate:
- Ventricular Assist Devices (VADs): Mechanical pumps that help the heart pump blood. They can be used as a bridge to transplant (temporary support) or as a destination therapy (permanent support for those not eligible for transplant).
- Medical Management: Optimised drug therapy to manage symptoms and improve quality of life.
- Palliative or Hospice Care: For patients where transplant or VADs are not options, focus shifts to symptom management and improving comfort.
A heart transplant is a life-saving but complex procedure. The decision to pursue one involves careful consideration by a multidisciplinary team of doctors, including cardiologists, surgeons, nurses, social workers, and psychologists.
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