Pre & Post Heart Transplant Care

Pre & Post Heart Transplant Care

Dr. Hamdan has become one of the fastest-growing pre & post transplant care cardiologist in the United States – completing more pre & post heart transplants care than any other cardiologist in Paterson, NJ.

The Heart & Vascular program lead by Dr. Aiman Hamdan is known for innovation leading to outstanding outcomes. From isolating the genetic origins of life-threatening thoracic aortic aneurysms to advanced imaging technology that allows cardiologists to detect heart disease early enough to reverse it, Dr. Hamdan’s groundbreaking accomplishments put it among the leading heart programs in the world.

Dr. Aiman Hamdan ensures patients access to cutting-edge programs and technology.

Dr. Aiman Hamdan, recognized by the Society of Cardiovascular Patient Care (SCPC) for the quality of care provided to patients.

When Is Heart Transplant Necessary?

A heart transplant is a surgical procedure that replaces a diseased or defective heart with a healthy heart from a donor. It is performed when other treatments for coronary problems have not been effective. A transplant gives a patient with congenital heart disease an opportunity to have a normal heart with normal blood circulation.

Conditions that could lead to a transplant

Advanced heart failure is staged on a four-point scale, the last of which is end-stage heart failure. At this point, medications and other treatments become ineffective and heart transplantation may become the only option.

Heart failure in adults can be caused by:

  • coronary artery disease
  • cardiomyopathy: a weakening of the heart muscle
  • heart valve disease or ventricular failure
  • a congenital heart defect
  • failure of a previous heart transplant

When is heart transplant an option?

Patients who have severe functional impairment with no medical or surgical therapeutic options and are referred for transplantation undergo a rigorous medical, psychological and social evaluation. On the basis of this evaluation, previous medical records and psychosocial information, a decision is made by the Medical Review Board at the Center for Advanced Heart Failure regarding the advisability of cardiac transplantation.

Patients who are considered for transplantation:

  • Suffer from
    • Advanced heart failure (defined as NYHA Class IIIB or IV), refractory to optimized medical therapy
    • Severe coronary artery disease with intractable angina despite optimized medical therapy that is not amenable to bypass surgery or angioplasty OR
    • Malignant ventricular arrhythmias refractory to all other accepted therapeutic modalities
  • Are generally less than 70 years old
  • Do not have multi-organ dysfunction
  • Exhibit psychosocial stability and have a supportive social environment
  • Demonstrate financial responsibility for maintenance of post-transplant medications and testing

What conditions would prevent a transplant?

Not all patients with advanced heart failure are eligible for a heart transplant. Generally, those who meet one or more of these criteria are not recommended:

  • 70 years of age or older
  • Suffer from another medical condition that could shorten life, regardless of receiving a donor heart
  • Have serious blockages in the arteries in arms or legs (peripheral artery disease)
  • Have a personal medical history of cancer
  • Are unwilling or unable to make lifestyle changes that are necessary to keep a donor heart healthy, including not drinking alcohol or smoking

Preparing For Heart Transplant

Approved transplant candidates are placed on the United Network for Organ Sharing (UNOS) list while awaiting transplant. During this time, the transplant team monitors the patient to ensure his or her condition remains stable. Should the patient’s condition begin to decline, other innovative procedures such as intravenous medications and left ventricular assist device (LVAD) implantation may be recommended until a compatible donor heart is located.

When a donor heart becomes available, the donor-recipient matching system considers several factors in finalizing a match:

  • The medical urgency of the potential recipient’s condition
  • Blood type compatibility (A, B, AB or O)
  • Antibodies developed by the recipient
  • Whether the donor organ is appropriately sized
  • The time a potential recipient has spent on the waiting list

Once a donor heart has been identified, the patient is called to the hospital immediately, where a thorough evaluation is conducted on the donor organ and the patient.

Heart Transplant Risk

What are the risks involved in a heart transplant procedure?

Although receiving a donor heart can save a person’s life, transplantation is an open-heart surgical procedure accompanied by serious risks, the most significant of which is rejection. All heart transplant recipients receive immunosuppressants (medications that reduce the activity of the immune system), but about one in four have some signs of rejection during the first year after surgery. Usually the rejection has no symptoms and requires only an adjustment of medications.

Short-term risks can include:

  • Arrhythmia
  • Bleeding
  • Stroke
  • Donor organ dysfunction
  • Hyperacute or acute rejection
  • Infection
  • Kidney failure

Long-term risks can include:

  • Cancer
  • Coronary disease
  • Chronic rejection
  • Hypertension
  • Infection

Although the specific risks and potential benefits of a heart transplant vary for each patient, Dr. Hamdan will discuss all possibilities in detail and take strict precautions to decrease these risks.

Heart Transplant Surgery

The surgical process

Heart transplant is performed under general anesthesia with the patent on a bypass machine, which keeps oxygen-rich blood flowing throughout the procedure. It generally lasts four to six hours, longer if the patient has had previous coronary surgery or if there are complications. The surgeon exposes the chest cavity and opens the pericardium. The diseased heart is removed, leaving the back part of the left atrium in place. The donor heart is implanted and the chest is closed. In some patients both heart and lungs may be transplanted during the same procedure.

Following surgery

Immediately after surgery, patients receive pain control medication. A ventilator is used to help a post-operative patient breathe and tubes are inserted in the chest to drain fluids from around the lungs and heart.

The post-surgery hospital stay will last one to two weeks. For about three months afterward, transplant recipients are closely monitored on an outpatient basis, including blood work, echocardiograms, electrocardiograms and heart biopsies.

Long-term recovery

After a heart transplant, patients must make some permanent long-term adjustments, including:

  • Taking immunosuppressants, which are required to prevent the immune system from rejecting the new heart. These drugs may cause some significant side effects, including weight gain, facial hair or stomach problems, but many of these decrease in severity as time passes. Because they suppress the immune system, however, a patient is more susceptible to infections, so the physician may also prescribe anti-viral, anti-bacterial or anti-fungal drugs.
  • Cardiac rehabilitation and lifestyle changes such as regular exercise and diet that keep a transplanted heart healthy. Diets may restrict calories, fluids, salt, fats, carbohydrates and/cholesterol and exclude consumption of alcohol, which adversely affects the function of immunosuppressants in preventing rejection.
  • Emotional support to deal with the inevitable stress and changes that follow a transplant. Dr. Hamdan’s support group for heart patients, their families and caregivers.

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