تعريف

This is surgery to remove a severely diseased and failing heart. It is replaced with a healthy heart from a deceased donor.

زرع قلب

أسباب هذا الإجراء

A heart transplant is done if you have:

  • End stage heart disease that is life threatening and cannot be fixed (but you are in otherwise good health)—This is most often due to cardiomyopathy (disease of the heart muscle) with severe congestive heart failure.
  • Severe coronary artery disease that cannot be fixed with medicine or other surgeries
  • Congenital heart defects
  • Valvular defects making it too hard for the heart to pump blood through the body
  • Uncontrollable life-threatening irregular heart rhythms

المضاعفات المحتملة

If you are planning to have a heart transplant, your سيقوم الطبيب بمراجعة القائمة من المضاعفات المحتملة، والتي قد تشمل:

  • العدوى
  • Rejection of the new heart
  • Coronary artery disease (50% of all heart-transplant recipients develop coronary artery disease)
  • التهاب رئوي
  • Blood clots
  • نزيف
  • Decreased brain function
  • Damage to other body organs, such as the kidneys
  • معدل ضربات القلب غير المنتظم
  • المشاكل المتعلقة بالتخدير
  • Infection or cancer related to taking immunosuppressive medicines
  • موت

More than 80% of heart transplant patients live for at least one year after surgery. Most return to normal activities, including work and يمارس.

بعض العوامل التي قد تزيد من خطر المضاعفات تشمل:

  • العمر: 60 سنة أو أكثر
  • أمراض الرئة
  • ضعف الدورة الدموية
  • أمراض الكلى أو الكبد
  • التدخين
  • Presence of serious active infection, such as pneumonia or tuberculosis
  • Treatment for cancer within the past five years
  • Debilitation and malnourishment
  • Uncontrolled diabetes
  • Previous stroke or other damage to the blood vessels of the brain
  • Continued substance abuse or alcohol abuse
  • مرض يصيب جهاز المناعه

تأكد من مناقشة هذه المخاطر مع طبيبك قبل الإجراء.

ما يمكن توقعه

قبل الإجراء

There is a shortage of donors, so you may be on a transplant list for some time. You may need to carry a cell phone with you at all times. This is to allow the transplant team to reach you if a donor heart becomes available. You may need to stay in the hospital for monitoring. You may need to be on continuous IV medicines to help stabilize the function of your diseased heart. Some may need to have a mechanical pump called a ventricular assist device (VAD). The device will help to stabilize your heart while you are waiting for a transplant.

  • Your doctor will monitor your health to make sure that you are ready for the heart transplant.
  • Talk to you doctor about all medicines you are taking. You may be asked to stop taking aspirin or other anti-inflammatory drugs for one week before surgery. You may also need to stop taking blood-thinning medicines, such as Clopidogrel (Plavix) or Warfarin (Coumadin).
  • Do not take over-the-counter medicine without checking with your doctor.
  • رتب لتوصيلة من وإلى المستشفى.
  • رتبي للحصول على المساعدة في المنزل بعد الجراحة.
  • تناول وجبة خفيفة في الليلة السابقة للجراحة. لا تأكل أو تشرب أي شيء بعد منتصف الليل.

Before the surgery, your doctor will likely do the following:

  • اختبار بدني
  • قسطرة القلب
  • Echocardiogram—a test that uses high-frequency sound waves (ultrasound) to examine the size, shape, and motion of your heart
  • Identify your blood and tissue type
  • Tests to exclude diseases in other organ systems that may prevent you from receiving a transplant

التخدير

General anesthesia will be used. It will block pain and keep you asleep through the surgery. It is given through an IV in your hand or arm.

وصف الإجراء

After you are asleep, the doctor will cut through the skin and breastbone. She will open the chest and connect you to a heart-lung machine. This machine takes over the functions of the heart and lungs during surgery. The doctor will then remove your heart. The donor heart will be prepared and sewn into place in your chest. Next, the blood vessels will be connected. After this, the blood will start to flow and warm the heart.

The new heart may begin beating on its own, or the doctor may give you an electrical shock to get your heart started. For safety, you will also have a temporary pacemaker attached to the heart to help the heart beat stay regular. Once the doctor is sure that the heart is beating fine, the blood will be rewarmed. The heart-lung machine will be disconnected. Next, temporary tubes may be placed in the chest cavity to drain any blood that has collected. The doctor will close the chest with stainless steel wires. Lastly, the skin will be closed with absorbable sutures.

مباشرة بعد الإجراء

You will be closely monitored in the intensive care unit (ICU) with the help of some/all of the following devices:

  • مراقبة القلب
  • Pacing wires used to help the heart beat normally
  • Tubes connected to a machine that helps drain excess blood and air
  • Breathing tube, until you can breathe on your own

كم من الوقت سيستغرق ؟

8 hours

هل سيكون هناك ألم؟

سوف تشعر بالألم أثناء عملية الشفاء. سيعطيك طبيبك دواء مسكن للألم.

متوسط ​​الإقامة في المستشفى

This procedure is done in a hospital setting. The usual length of stay is at least two weeks. Your doctor may choose to keep you longer if you shows signs of rejecting the new heart or have other problems.

رعاية ما بعد العملية

في المستشفى

أثناء تعافيك في المستشفى ، ستحتاج إلى:

  • Breathe deeply and cough 10-20 times every hour.
  • Take immunosuppressive drugs—You will likely need to take these for the rest of your life. These drugs reduce the chance that your body will reject the new heart.

Your doctor may need to take a biopsy of your heart routinely and additionally as needed if you:

  • Have persistent fever
  • Have poor heart function
  • Do not feel well

في البيت

عندما انت العودة إلى المنزل، قم بما يلي للمساعدة في ضمان التعافي السلس:

  • Take medicines as directed.
  • Return as prescribed by your transplant cardiologist for follow up biopsies.
  • Work with a physical therapist. تذكر that your new heart will respond slowly to increases in physical activity.
  • اسأل طبيبك حول, عندما هي آمنة للاستحمام, السباحة, أو نقع في الماء.
  • تأكد من اتباع تعليمات طبيبك.

The surgical site in your breastbone will heal in 4-6 weeks.

استدعاء الطبيب

بعد مغادرة المستشفى، اتصل بطبيبك إذا حدث أي مما يلي:

  • علامات الإصابة, بما في ذلك حمى وقشعريرة
  • احمرار أو تورم أو ألم متزايد أو نزيف مفرط أو إفرازات من موقع الشق
  • Changes in sensation, movement, or circulation in your arms or legs
  • Changes in the location, type, or severity of pain
  • Chest pain, pressure, or a return of your previous heart pain
  • Fast or irregular heart rate
  • Pain that is unrelieved
  • Cough, or shortness of breath
  • سعال الدم
  • الغثيان أو القيء الشديد
  • Sudden headache or feeling faint
  • Waking up at night due to being short of breath
  • Excessive tiredness, swelling of feet
  • ألم أو حرقة أو إلحاح أو كثرة التبول أو نزيف مستمر في البول

In case of an emergency, get medical care right away.

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