A heart transplant surgery is performed in cases of heart failure, that is when the heart fails to pump enough blood to the rest of the body. A heart failure may occur under the following conditions:

• Cardiomyopathy (heart muscle weakening)
• Heart valve disease (when one or more heart valves fail to function properly)
• Coronary artery disease (disease or damage in the major blood vessels of the heart)
• Congenital heart defect (heart defect present at birth)
• Recurrent ventricular arrhythmias (abnormal heart rhythms) not controlled by other treatment methods
• Failure of a prior heart transplant surgery

Symptoms:

The following are the symptoms of a heart failure, which may indicate the need for a heart transplant surgery:

• Chest pain
• Sudden gain of weight
• Flatulence
• Abnormal urination
• Fatigue
• Tiredness
• Difficulty in breathing
• Shortness of breath even during rest
• Changes in sleep pattern
• Difficulty in performing daily activities

The following diagnostic tests may be recommended before a heart transplant surgery:

1. Physical examination: The patient’s overall medical health status is evaluated. The patient’s symptoms, medical history, and family history are noted.
2. Blood tests: They help in finding a matching heart donor.
3. Urine test: This test is done to check for the presence of any infections.
4. Liver function test: This test is performed to diagnose any liver damage or disorder.
5. HIV test: This test is done to rule out an HIV infection.
6. Imaging tests: Tests like chest X-ray, CT scan, and MRI scan are performed to view the images of the internal organs of the body.
7. Echocardiogram, Electrocardiogram (ECG), Cardiac catheterization: These tests are performed to evaluate the heart condition.
8. Ultrasound: High-frequency sound waves are used in this test to create images of the internal organs of the body.

• The procedure is generally done under general anesthesia, that is, the patient is put to sleep during the procedure.
• The patient is placed on a heart-lung bypass machine during the procedure. This is done to keep the blood circulating throughout the body during the procedure.
• The surgeon makes an incision in the chest area.
• The chest bone is now separated by the surgeon and the rib cage is opened to obtain access to the heart.
• The diseased heart is now removed and replaced by a donor’s heart.
• The arteries and veins of the patient are then connected to the donor's heart.
• An electric shock may be given sometimes to make the donor’s heart beat properly.
• This is known as an open-heart procedure.
• The procedure takes up to four hours to complete.

The following risks are associated with a heart transplant surgery:

• Allergic reaction to the anesthesia used

• Bleeding

• Infection

• Blood clot formation

• Organ rejection

• Graft failure

• Kidney disease

• Kidney failure

• Hypertension (high blood pressure)

• Nerve damage

• Arrhythmias (irregular heart rhythms)

• Osteoporosis (a condition in which the bones become brittle and weak)

• Pain

• Stroke (damage to the brain due to interrupted blood supply)

• Heart attack

• Delirium (a disturbance in the mental abilities of a person)

• Depression

• Blood thinning caused by medications

• High cholesterol caused by medications
  

• The patient is given pain-relieving medications post-surgery.

• The patient is kept on a ventilator to aid in breathing.

• The doctor inserts tubes in the chest area for draining the fluids from and around the heart and the lung region.

• The patient can normally go home after a few days of heart transplant surgery. 

• The patient is instructed to avoid driving after the surgery.

• Immunosuppressant medicines are prescribed to the patient after surgery.

• The patient's vital parameters are monitored in the follow-up appointments.

• The patient is instructed to avoid lifting heavy objects and performing strenuous activities after the surgery.

• The patient is instructed to avoid swimming and bathing in the bathtub to prevent infection.

• The patient is instructed on how to keep the wound clean and dry after the procedure.