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Post OP Care

Post-Operative Care
After surgery, the patient is taken to the ICU. The recovery of the patient involves 1 – 2 weeks of staying in the hospital presuming there are no complications and 3 months of monitoring at the heart transplant center by members of the transplant team. At the transplant center, regular tests which include blood work, echocardiograms, electrocardiograms, heart biopsies and lung function tests are carried out. Depending on the general health of the patient, how well he is able to handle the new heart and how the heart is working, the in-hospital post-transplant care continues.

The patient has to keep coming for rehabilitation and regular check-ups though the frequency of the visits decreases with time. Many of these patients might even need emotional support, and immunosuppressant drugs have to be taken for the rest of the life. Immediately post-surgery, a biopsy is performed to monitor rejection. Once the patient is stable, this is replaced with a gene expression test which is known as AlloMap Molecular Expression Testing after around 55 days.

Complications Post-Surgery and Follow-up
Infection and rejection are the most common causes of death of a heart transplant patient. Since the transplanted heart has its origin in another organism, the immune system of the recipient attempts to reject it. Hence, the patient is started on life-long immunosuppressive drugs the day before the transplant. Patients who have been prescribed anti-rejection drugs are at risk of developing damage to the kidney, osteoporosis, high blood pressure and lymphoma which is a type of cancer infecting the immune system cells. While half of the patients develop coronary artery disease, many of them have no symptoms of angina because of the unavailability of any sensation in their new hearts.

  • Hence, complications post-transplantation can include the following:
    Bleeding from suture line
    Hyperacute rejection
    Cardiac rejection
    Psychiatric disturbances arising from steroid therapy
    Allograft vascular disease
    Rejection remains one of the most common causes of death post surgery. To prevent the risks of rejection, patients are prescribed immunosuppressant for the rest of their lives in order that the immune system is suppressed so as not to damage the new heart.

Myocardial Biopsy: Patients are carefully monitored after heart transplantation and endomyocardial biopsies are performed in order to assess allograft rejection. These may be done as frequently as every week during the first three to six weeks after the procedure, reducing to once every three months and ultimately on an annual basis. Since the new heart may be rejected, the receiver should be aware of the possible signs of rejection which include the following:

  • Fever over 100.4` F (38` C)
  • Symptoms resembling flu-like chills
  • Headaches, nausea, dizziness and / or vomiting
  • New chest pain or tenderness
  • Shortness of breath, fatigue and
  • Elevation in blood pressure

Watching for Infection : Too much immunosuppressant after the surgery may tend to make the immune system sluggish leading to severe infections in the patient. Hence, regulation of immunosuppressant is also adjusted during the first month which necessitates regular visits during this time with the frequency of visits reducing to annual visits only over time.
Possible signs of infection may include the following symptoms which are to be brought to the notice of the doctor immediately.

  • Fever over 100.4` F (38` C)
  • Skin rash
  • Sweating or chills
  • Pain, tenderness, swelling or redness
  • A wound or a cut which refuses to heal
  • A red or draining sore
  • Sinus drainage, nasal congestion, tenderness along the upper cheekbones or headaches
  • Sore or scratchy throat or pain while swallowing food
  • A persistent moist or a dry cough lasting for more than two days
  • Nausea, diarrhea or vomiting
  • White patches in the mouth or on the tongue
  • Flu-like symptoms such as chills, aches, fatigue or headaches
  • Trouble in urinating, constant urge to urinate or frequent urinating, pain or burning sensation while urinating and
  • Bloody or foul-smelling urine

Some centers also perform coronary angiography annually so that the patient is monitored for probable development of allograft vascular disease.

Lifestyle Changes after Cardiac Transplantation
Though lifelong medications are prescribed for a heart transplant patient in order to avoid rejection of the new organ, many of these people lead a long and active life. However, heart transplant patients need to keep a few things in mind:

  • Medications: Patients, who have undergone heart transplant need to take drugs that might induce side effects which include high blood pressure, excessive growth of hair, fluid retention, kidney damage, and bone thinning. In order to counter these effects, patients are prescribed additional drugs.
  • Exercise: Regular exercise is a must for heart transplant patients so that they can improve the function of the new heart and also avoid gaining weight. However, exercises should be carried out under medical supervision only.
  • Diet: The patient may also need to make changes in his diet post-heart transplant surgery. However, the dietary changes remain the same as those which were made prior to the operation. A low-fat, low-sodium diet is essential to decrease risks of heart disease, fluid retention, and high blood pressure. The specific dietary needs can be consulted with the doctor. A dietician can help with specific dietary guidelines.

Prevention of Heart Diseases
Heart Diseases can prove deadly if not cared appropriately but what is just as vital as a cure is a prevention. If you take certain safety measures and lead a healthy lifestyle, then it is likely to prevent the onset of heart diseases. Following are some of the precautions that could be observed to stop the heart diseases from occurring: -

  • Abstain from Smoking: - Chain smokers are at high risk of developing heart diseases and suffering from heart attacks. If you want to be safe from heart diseases, give up smoking completely.
  • Take up an active lifestyle: - Regular exercise and workout significantly reduce the chances of heart diseases. Develop a healthy workout routine in consultation with your doctors.
  • Manage Blood Sugar Levels: - High blood sugar levels are one of the leading causes of severe heart ailments. Monitor your blood sugar levels closely and take regular medications to save your heart from damage.
  • Manage Blood Cholesterol: - High Cholesterol levels, including HDL and LDL, significantly increase the risk of heart diseases. Monitor your cholesterol levels closely and remove saturated fats, oils, and refined sugar from your diet.
  • Follow Healthy Eating Habits: - Ensure that your diet is low in fats and cholesterol. Eat more of green vegetables, fruits, whole grains, fiber-rich foods, nuts, and cereals, etc. to keep your heart in a good shape.
  • Monitor High Blood Pressure: - Hypertension and high blood pressure are one of the chief culprits behind heart diseases. Monitor your blood pressure levels regularly, take healthy diet and do exercise. If required take medications in consultation with a physician to keep the blood pressure levels in check.
  • Manage Stress Levels: - Everyone is bound to be stressed and loose temper sometimes in life. But doing so repeatedly is not a good sign. Take up a healthy lifestyle including meditation to manage the stress levels and ensure that there are no adverse effects on the heart.
  • Manage Healthy Weight Levels: - If your BMI is above 30, then it’s an indication for heart diseases. Manage your weight levels with exercise and healthy diet. Losing extra weight will help in managing high blood pressure and heart conditions. 

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