How is a heart transplant performed?

After the patient is asleep, a device called the Swan-Ganz catheter is often inserted into the jugular vein (in the neck) and threaded to the pulmonary artery (which goes from the heart to the lungs). The catheter is used to measure heart function and pressures in the heart and lungs. It is also used to give medication and to measure the oxygen levels in the blood. A breathing tube (endotracheal tube) will be inserted into the mouth and down the windpipe (trachea) to maintain an airway.

An incision is made through the chest and breastbone (sternum), and the ribs are separated. A heart-lung machine will take over the functions of the heart and lungs, freeing the heart from its normal function so that it can be removed. Some heart muscle is left during extraction to act as a support for the new heart as it is sewn into place.

When the new heart is positioned and the blood vessels are reattached, the heart incision is closed, the heart is restarted and blood circulation and oxygen are restored. The warmth of the blood should “wake up” the heart and stimulate it to start beating. If this does not occur, it may be necessary to start the heart using an electric shock (defibrillation). Once the blood is flowing through the new heart normally and without any leaks, the heart-lung machine is disconnected and the chest incision is closed.

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