A heart transplant is a complex surgical procedure where a diseased heart is replaced with a healthy donor heart. This operation is typically reserved for individuals with end-stage heart failure who have not responded to other medical treatments. While the surgery follows a well-established protocol, the total time a patient spends in the operating room varies significantly. This variation is due to necessary preparation and immediate post-operative steps required to ensure the best possible outcome.
Preparing for the Operation
The timeline begins with the urgent notification that a suitable donor heart is available. Because the donor heart has a limited viability window outside the body—ideally less than four hours—the recipient must arrive at the hospital immediately. Once admitted, a final evaluation, including blood work and imaging, confirms the patient’s readiness for the procedure.
A crucial preparatory step is the cross-match compatibility test, which checks for antibodies that could immediately reject the donor organ. The results of this quick test determine if the transplant can safely proceed. Simultaneously, the surgical team responsible for procuring the donor heart is often traveling to retrieve the organ.
The patient is then moved to the operating room, where general anesthesia is administered. Monitoring lines are placed, including an arterial line for blood pressure measurement and central lines for rapid medication administration. This preparation phase, from arrival to the first incision, can add several hours to the total time the patient spends in the operating environment.
The Surgical Procedure Timeline
The time spent actively performing the heart transplant procedure typically ranges between four and six hours. However, this duration can extend to six to eight hours or more if the patient has had previous heart surgeries or if a ventricular assist device (VAD) must be removed before the replacement. The procedure is broken down into four main phases.
The first phase involves making a median sternotomy incision to access the heart, followed by connecting the patient to the cardiopulmonary bypass machine. This heart-lung machine temporarily takes over the function of both the heart and lungs, circulating oxygenated blood throughout the body. The setup and connection to the bypass machine is a precise, time-consuming step that prepares the patient for the core of the transplant.
The second phase is the removal of the patient’s diseased heart, known as the cardiectomy. The surgeon separates the diseased heart from the great vessels, leaving cuffs of the recipient’s atria and the main artery connections. Once the old heart is removed, the third and most time-sensitive phase begins: the implantation of the donor heart, or anastomosis.
During implantation, the surgeon sews the donor heart into place by connecting the major blood vessels and atrial cuffs. This suturing process, which reconnects the major vessels, is the most delicate part of the operation. It must be completed quickly to minimize the donor heart’s cold ischemic time and restore blood flow to the new heart—a process called reperfusion.
The final phase involves weaning the patient off the cardiopulmonary bypass machine once the new heart begins to beat. The surgical team assesses the function of the new heart and ensures all connections are secure before closing the chest incision. Successfully weaning off bypass marks the end of the surgical time, but the patient remains under close observation for hours afterward.
Immediate Post-Operative Monitoring
Following surgical closure, the patient is immediately transferred to the Cardiovascular Intensive Care Unit (CVICU) for intensive monitoring. The initial 24 to 48 hours focus on achieving hemodynamic stability. The care team monitors for primary graft dysfunction (PGD), a serious complication where the new heart fails to pump effectively after transplantation.
The patient remains on a ventilator until stable enough to breathe on their own, a process called extubation, which typically occurs within the first day. Temporary pacing wires are often left in place to manage the new heart’s rate and rhythm, since the donor heart’s nerves are not immediately reconnected. Intravenous medications support the function of the new heart as it recovers from the stress of the transplant.
Immunosuppressant therapy is initiated immediately to prevent hyperacute rejection, which is the body’s rapid, severe immune response against the foreign organ. Close monitoring of blood pressure, heart rhythm, and fluid balance is continuous. The patient generally remains in the ICU for several days before being moved to a specialized transplant recovery floor.