What is congestive heart failure?
Congestive heart failure (CHF) happens when the heart’s weak pumping action causes a buildup of fluid called congestion in the lungs and other body tissues. Those at risk for developing CHF have the following:
- Coronary heart disease
- Previous heart attacks
- High blood pressure
- Irregular heartbeat
- Congenital heart defects
- Heart valve disease
- Alcohol and drug abuse
What treatment options are available for heart failure?
- Medical Therapy
- Biventricular Pacemaker Device
- Left Ventricular Assist Device
- Orthotopic or heterotopic heart transplantation
Who can be considered for heart transplantation at Baylor St. Luke’s Medical Center?
The only absolute contraindications to transplant are malignancy not cleared by an oncologist, hepatic cirrhosis, severe chronic obstructive pulmonary disease, and severe elevated pulmonary vascular resistance and untreated psychosis.
Who determines if I am a transplant candidate?
Medical Review Board. When your evaluation is complete, your case will be presented to the Board. The Medical Review Board consists of transplant cardiologists, transplant surgeons, transplant coordinators, dieticians, social workers, and financial counselors. Their goal is to determine the best treatment option for you and they will determine if you are a candidate for transplant.
How do I start the evaluation process?
In most cases, your personal cardiologist will make the first inquiry about a transplant. Information that will be required from your cardiologist includes your insurance information.
What should I expect during the evaluation process?
A standard set of tests including labs and radiology imaging give a clear picture of your overall health status. They also help to identify potential problems before they occur. We try to determine whether or not transplantation is truly the best option for you.
What tests should I expect to have done during my evaluation?
- Abdominal Ultrasound - Examines the kidneys, liver, and gallbladder for the presence of cysts, stones, or other abnormalities.
- Blood tests - Blood test help assess your overall physical condition.
- Cardiac tests - These tests will assess your heart function and will include an echocardiogram, electrocardiogram (EKG or ECG), cardiac catherization, and a stress test.
- Chest X-ray and CT scan of the chest- These tests assesses the size of your heart and any lung abnormalities.
- Colonoscopy - A procedure to screen for colon cancer on anyone over age 50
- Gynecological Exams - All women will need a gynecological exam within the last year
- Mammogram - This test is required for all women over the age of 40.
- Physical Exam - This gives the doctor an overall picture of your condition.
- Pulmonary function study - This test will identify any lung problems that need to be addressed prior to transplant.
- TB Skin testing- A small amount of solution is injected under the skin on your forearm to determine if you have been exposed to tuberculosis. Everyone is different, therefore, every evaluation will be tailored to each individual.
- Interview with the financial counselor, dietician and social worker – This is to identify potential post transplant problems to develop a plan of action prior to the transplant
If I am accepted for transplant, how long will I have to wait?
If you are accepted for transplantation, you will be placed on a national computer list of active candidates waiting for a suitable donor. Recipients are chosen according to a complex set of criteria, including blood type, body and organ size, medical condition, and length of time on the waiting list. The United Network for Organ Sharing (UNOS) coordinates the equitable sharing of organs throughout the United States and oversees all donor centers and procurement agencies. The waiting period can be several months to several years, while the transplant team searches for the appropriate heart for you. The transplant coordinators must be able to locate you 24 hours a day and you must be able to reach the hospital within a reasonable amount of time.
What are my responsibilities while waiting for transplant?
While on the transplant list, you must maintain active medical insurance. Failure to do so may impact your ability to receive a new heart. You must notify the transplant center if there are any changes in:
- Address or phone number
- Medical condition
- Surgeries/ hospitalizations
- Blood transfusions
What is the process like once a heart is found for me?
When a potential donor is found, the coordinator will call to notify you (it is very important to keep us aware of any change in address or phone number). If there is no answer, the coordinator will then page you. Once contact is made, the coordinator will instruct you on where to report and ask you not to have anything else to eat or drink prior to the transplant. When you come for surgery, please remember to bring:
- A current medication list
- A list of your drug allergies
- Current health insurance information (your most recent insurance cards)
What happens when I get to the hospital for surgery?
After admission, the patient will have blood work and may have an intravenous line placed to monitor the heart pressures. Unfortunately in some cases, the surgery has to be canceled after you have arrived at the hospital. Some reasons are:
- Poor heart function noted after visualizing the donor heart
- Additional medical problems
What will my surgery be like?
- The surgery usually takes 4-6 hours
- The incision will be in the middle of your chest
- A breathing tube will be inserted to assist you with breathing while you are sedated
How long will I be in the hospital after my surgery?
- After your transplant, the recovery time varies. Some patients may be discharged from the hospital within 7-10 days and others require longer recovery times.
- If you live out of the Houston area, you are typically required to stay in the area for approximately three months.
What will be expected of me after transplant?
- You will have to follow up frequently for lab work and biopsies initially. Biopsies are done to determine if there is any rejection and can be done as an outpatient procedure after you are discharged from the hospital. We will perform many biopsies during your first year after transplant. You will need to have lab work drawn every one to two weeks for the first three months after transplant.
- There are several factors that will help you keep your new heart healthy. It will be important to follow a healthy lifestyle. You will need to exercise regularly, maintain a healthy diet, and keep a weight that is appropriate for your body frame. You will be expected to help your transplant team monitor your care by keeping records of your blood pressure, blood sugar, weight, temperature and pulse.
When will I be able to return to work or school?
- This time will vary for each person. Ideally you should be able to return to work or school about three months after transplant if your condition is stable. Most patients are able to return to a healthy level of normality about this time.