Patients who have had heart transplant surgery at the Hospital of the University of Pennsylvania awaken after their surgery in the surgical intensive care unit (SICU).
They are attached to many tubes and see medical equipment surrounding the bed. Patients who have had open-heart surgery are familiar with what to expect. A breathing tube and ventilator assists them with breathing during surgery and while waking up. Patients are unable to talk while the tube is in place. Typically, the breathing tube is removed when patients are fully awake from the anesthesia — usually within 24 hours after surgery. Soft restraints are placed on patients' wrists to keep them from accidentally pulling on tubes as they wake up. The restraints are removed once patients are awake.
Following surgery, patients receive medications through an intravenous (IV) line and catheters are placed in the neck, arms, bladder and wrist to assist with monitoring blood flow and blood pressure, and to drain urine from the bladder.
Cardiothoracic Step-Down Unit
When their condition is stabilized, usually two to three days following heart transplant surgery, patients are transferred to the cardiothoracic step-down unit. Transplant patients have a private room while in the hospital to protect them from infection. Although family and friends may visit, they are asked to avoid visiting if they have a cold, fever or feel sick. Everyone entering the room must first wash their hands.
After moving to the step-down unit, patients take the first steps in their journey as a heart transplant recipient. During this recovery time, patients are followed by the multidisciplinary heart transplant team for care and preparation for discharge. Patients undergo ongoing testing and medication adjustment, especially for their immunosuppression (anti-rejection) medications, as well as their first endomyocardial heart biopsy to evaluate any evidence of rejection.
Patients begin exercise under the direction of physical and occupational therapists. The therapists evaluate patients' strength and exercise ability, and patients undergo one-on-one therapy and group physical therapy sessions. This is the start of returning to physical fitness. In addition, patients receive information about diet and exercise.
The heart transplant program offers learning sessions for patients, family members and caregivers to prepare for discharge and life as a heart transplant recipient. These classes are very important because transplant recipients are on lifelong medications to prevent rejection and must be attentive to side effects and signs of infection or rejection.
The first three to six months following the transplant are a period of adjustment for patients, their family and friends. Patients are unable to drive for six to eight weeks following surgery, and come to the Penn Transplant Institute weekly — sometimes twice weekly — for checkups. In addition, patients with other medical conditions are directed to follow-up appointments with providers from other specialties, such as endocrinology (diabetes) or nephrology (kidney). After several weeks, the visits become less frequent.
With proper care, most heart transplant patients are able to resume an active lifestyle, including playing sports and working a full-time job. The transplant team continues lifelong monitoring of all transplant recipients, monitoring for infection, rejection and the effects of drug therapy.
Ongoing disease prevention is encouraged as the key to continued good health. Patients continue their care with their primary care physician or clinic after their heart transplant for other health problems, immunization updates and to track their general health.
Transplant recipients are at higher risk of developing transplant coronary disease and cancer, particularly skin cancer, throughout their lives. Patients undergo annual evaluations that include:
- Blood work
- Stress test
- Cancer screening
- Complete physical
It is very important for patients to continue the lifestyle of exercise, eating a healthy low-fat and low-sodium diet, practicing good hygiene and to remaining smoke-free they developed during the heart transplant process. The transplant team provides support in these endeavors.