Heart Transplant Procedure: Step-by-Step Overview

Orthotopic Heart Transplantation: Surgical Sequence

Donor Evaluation: Brain-dead donor; hemodynamic stability, echocardiogram, coronary angiography (if >40), serologies, HLA typing, size match.
Recipient Evaluation: End-stage heart failure refractory to medical/device therapy; psychosocial/financial clearance; sensitization (PRA) assessment.
Organ Procurement: Median sternotomy, heparin, cardioplegia, aortic cross-clamp, heart excision, cold storage (Custodiol/HTK) – ischemic time <4 hrs ideal.
Recipient Preparation: Sternotomy, CPB initiation, bicaval cannulation, recipient cardiectomy (bicaval or biatrial technique).
Implantation: Left atrial cuff → donor LA; IVC/SVC anastomoses; pulmonary artery; aorta. De-air, wean CPB.
Immunosuppression Induction: Intraoperative: methylprednisolone, basiliximab/ATG, tacrolimus/MMF/prednisone.
ICU Management: Hemodynamic optimization, rejection surveillance (endomyocardial biopsy, gene expression profiling), infection prophylaxis, renal/hepatic monitoring.
Rehabilitation: Early mobilization, cardiac rehab, psychosocial support, lifelong immunosuppression adherence.

1-year survival: ~90%; 5-year: ~75%; 10-year: ~55%.
Major late risks: CAV (cardiac allograft vasculopathy), malignancy, infection, renal failure.