Margarita Camacho, MD, surgical director of heart transplantation, RWJBarnabas Health, RWJBarnabas Medical Group discusses what type of patients are candidates for a heart transplant, the transplant process and the exciting outcomes for transplant patients today.
TRANSCRIPT:
The patients that come to us who need transplants are usually those people who've had chronic heart failure to such a degree that they're really end-stage and there really aren't any great alternatives and they're beginning to fail on their current medications. So these are the vast majority of patients. Usually they have some form of coronary disease or if not, they might have some sort of a familial issue a genetic issue there are numerous causes for end-stage heart failure, but the most common one is coronary disease. When they come to us after really having exhausted all other medical therapies we start to work them up for heart transplant.
Once we've identified a potential heart transplant recipient we start a very long journey. In fact, as an outpatient, it can often take several weeks. There is a punch list of anywhere from 25 to 35 items looking at every single organ system in your body. We really have to make sure that you're an ideal candidate from every other aspect, and so from head to toe, we do all kinds of diagnostic tests -- imaging tests, blood tests -- just to make sure that you have a likelihood of having a good long-term survival once you have your heart transplant.
After the heart transplant -- immediately after -- it's actually a very rewarding experience for the medical staff because when the patient wakes up from the surgery almost always they feel great immediately and they tell you that they can breathe more easily their skin is actually pink which very often it wasn't before the transplant. In fact the usual pain that you have after any kind of open-heart operation from the incision is usually mitigated by the fact that you just feel so good after you have your new heart.
What you can expect in terms of the recovery right after heart transplant is about six weeks before you're almost fully physically recovered -- meaning that time you can drive, you can play golf -- immediately after the transplant, I would say within the first couple of days you're usually walking around. From the time that you come off the breathing machine, which is anywhere from several hours to -- in some patients who are complicated -- maybe a day or so, you're usually out of bed in a chair.
So the first six months after a heart transplant are probably the most crucial in terms of heeding all the do's and don't do's. You're told to stay away from any potential sources of infection because it's at that time that you're the most vulnerable.
You also have biopsies that get done of your heart. These are very simple procedures. They get done by the cardiologists. They often take anywhere from 10 to 20 minutes and it really just involves a catheter going into your jugular vein in your neck in the in the catheterization lab and under radiologic guidance. They take a tiny little piece of heart muscle a couple of them the size of pinheads and those get looked at by the pathologist to make sure you're not rejecting the heart.
Those procedures are done weekly for the first six weeks and then every two weeks after that and so forth and so on until you're out a year, at which point they're usually done annually.
The immunosuppression drugs are critically important. These are drugs that you need to take for the rest of your life, and they're exactly how they sound -- they're drugs that suppress your immune system. They help guarantee that you don't reject the donor organ and the education involved with that is pretty intense. it's done by the transplant coordinators and nurses right after the surgery while the patient's still in the hospital and they usually meet with the patient and the caregiver several times in the post-operative period. They go through rigorous education regarding how and when to take the medications other than that the patients that I've seen by and large have a terrific quality of life.