HEART-LUNG TRANSPLANTATION

General Information

DEFINITION--Replacement of poorly functioning lungs and a damaged or healthy heart with donor organs. If the recipient's heart is normal, it may be extracted and donated to another patient in need of of a heart transplantation only (see Heart Transplantation in Surgery section).

BODY PARTS INVOLVED--Lungs, heart, trachea and blood vessels.

REASONS FOR SURGERY--Chronic lung disorders such as pulmonary hypertension, emphysema, cystic fibrosis and other lung conditions causing pulmonary fibrosis.

SURGICAL RISK INCREASES WITH

• Adults over 60.
• Obesity.
• Smoking.
• Recent illness.
• Alcoholism or other chronic illness.
• Use of drugs such as: antihypertensives; muscle relaxants; tranquilizers; sleep inducers; insulin; sedatives; beta-adrenergic blockers; or cortisone.
• Use of mind-altering drugs, including: narcotics; psychedelics; hallucinogens; marijuana; sedatives; hypnotics; or cocaine.

What To Expect

WHO OPERATES--Cardiovascular surgeon, thoracic surgeon.

WHERE PERFORMED--Hospital.

DIAGNOSTIC TESTS

• Before surgery: Blood and urine studies; studies of the immune system; ECG; cardiac catheterization; echocardiography, ultrasound; biopsy; pulmonary angiography; lung function studies (See Glossary for all).
• During surgery: Cardiac monitoring (See Glossary).
• After surgery: Repeat of some tests for monitoring of the new organs.

ANESTHESIA--General anesthesia by injection and inhalation, with an airway tube placed in the windpipe.

DESCRIPTION OF OPERATION

• An incision is made in the recipient's chest to expose the heart and lungs.
• A heart-lung machine sustains life while the diseased organs are cut free (by severing the aorta and trachea) and removed.
• The donor organs are sewn into place. The new lungs are connected to the trachea.
• The skin is closed with sutures or clips, which usually can be removed about 1 week after surgery.

POSSIBLE COMPLICATIONS

• Excessive bleeding; blood clots.
• Surgical-wound infection.
• Life-threatening general infections.
• Rejection of transplanted organs.

AVERAGE HOSPITAL STAY--3 weeks.

PROBABLE OUTCOME--A successful transplantation prolongs life and improves the quality of life for patients who might otherwise have died. Allow about 6 weeks for recovery from surgery. Rejection of the transplant remains a risk indefinitely. If rejection can be controlled, the patient has a life expectancy of up to 10 years or longer.

Postoperative Care

† Move and elevate legs often while resting in bed to decrease the chance of deep--vein blood clots.

† You may use non--prescription drugs, such as acetaminophen, for minor pain.

ACTIVITY

• Rehabilitation will begin after surgery.
• Resume normal activity as soon as possible.
• Avoid vigorous exercise for 6 weeks after surgery.
• Resume sexual relations when your doctor determines that healing is complete.

† A combination low-fat, low--

salt diet may be prescribed by your doctor.

• Vitamin and mineral supplements (sometimes).

Call Your Doctor If

† Pain, swelling, redness, drainage or bleeding increases in the surgical area.

• You develop signs of infection.
• You experience any new symptoms.