A heart transplant replaces a patient’s diseased and failing heart with a healthy heart from a donor. This operation is considered for patients whose severe heart failure has not responded to other treatments. The time spent in the operating room is only one component of a much longer, complex journey that begins with rigorous patient preparation and extends into intensive post-operative monitoring.
The Core Surgical Timeframe
The duration of the actual heart transplantation surgery, measured from the initial incision to the final closure of the chest, typically falls within a range of four to six hours. This timeframe represents the combined effort of a large, specialized team. The process begins with the administration of general anesthesia and the meticulous preparation of the patient.
A major step involves connecting the patient to a cardiopulmonary bypass machine, or heart-lung machine, which temporarily takes over the function of pumping and oxygenating blood. This allows the surgical team to work on a still, bloodless heart. Once on bypass, the surgeon removes the recipient’s diseased heart by dividing the great vessels.
The donor heart is then implanted and connected to the recipient’s major blood vessels and heart chambers through delicate surgical connections called anastomoses. The speed of the surgical team is important during this phase to minimize the “ischemic time,” the period when the donor heart is without a blood supply and oxygen. This period is defined as the time from the donor aorta being clamped to blood flow being restored in the recipient.
Minimizing ischemic time is related to the new heart’s function and long-term success, with four hours often considered the goal. Once the new heart is connected, blood flow is restored, and the organ is warmed, allowing it to begin beating on its own. The surgical team then carefully removes the patient from the heart-lung machine, ensuring the implanted heart can sustain circulation independently.
Factors Affecting the Procedure Length
The four-to-six-hour timeframe represents a standard, uncomplicated heart transplant, but several patient-specific factors can extend the procedure’s duration. The most common cause for a longer operation is a history of previous open-heart surgeries, known as re-operative status. Prior surgery leaves behind scar tissue and adhesions, which are tough, fibrous bands.
The surgeon must meticulously dissect and clear this scar tissue before accessing the heart and great vessels, which can add multiple hours to the procedure. Patients who have had a ventricular assist device (VAD) implanted before the transplant also face a longer operation. The VAD must be carefully explanted and the heart repaired before the donor heart can be implanted.
Anatomical variations or the presence of significant calcification in the chest can also complicate the surgical field and slow down the process. The complexity of these preparatory steps causes the total operating room time to fluctuate, sometimes pushing the duration toward six to eight hours or more.
Transitioning from Surgery to Intensive Care
The core transplantation phase concludes once the new heart is beating, the patient is stabilized off the bypass machine, and the surgical team confirms there is no excessive bleeding. The next stage is the closure of the chest, which can take an additional hour or more. This involves placing drainage tubes, or chest tubes, around the heart and lungs to remove accumulating blood or fluid.
The sternum, or breastbone, is then carefully rewired and the chest incision is sutured closed in layers. Throughout this closing process, the anesthesiologist works to reverse the effects of the anesthesia, preparing the patient to be moved while remaining sedated and on a ventilator. The patient is immediately transferred from the operating room to the specialized Cardiac Intensive Care Unit (CICU).
The first 24 to 48 hours in the CICU are a period of intensive monitoring. The focus is on achieving hemodynamic stability, meaning the new heart is effectively pumping blood and maintaining a stable blood pressure. The care team monitors for excessive bleeding, the initial function of the new heart, and the body’s early response to the immunosuppressive medications given to prevent organ rejection.