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How Heart Transplants Give Patients a New Life

A heart transplant is a treatment of last resort for end-stage heart failure. A heart transplant helps to restore normal heart function and therefore enables a patient to return to normal functional abilities. This comes at a cost, though, as there are risks to this operation and many medications to take for the rest of the patient’s life. Women’s Cardiovascular Healthcare Foundation supports women who have had a heart transplant.

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Main causes of heart failure are ischemic heart disease (myocardial infarction) and primary cardiomyopathy, a disease of the heart muscle (myocardium) that can be genetic. Around 30% of transplant patients are women. Among these women, there is a rare but specific cause: peripartum heart disease (period around childbirth), as well as an increasing proportion of ischemic heart disease (due to damage to the heart, or coronary arteries) linked to increased stress, sedentary lifestyles and smoking among women.

A patient on the national waiting list is allocated a transplant (a heart) by the biomedicine agency based on the severity of her cardiac situation, estimated in part by the Heart Score, which depends on her blood type and morphologic match with the donor. For some patients, often women who have been immunized following pregnancy, HLA compatibility between the donor’s and recipient’s antibodies is also necessary. For these immunized patients, the wait time is often prolonged and access to a transplant is limited. Due to the shortage of donor organs, estimated at two (one organ for every two recipients waiting), the use of an artificial heart is often suggested as an alternative solution while the patient is waiting.

The main factor limiting the use of some of these artificial hearts (biventricular or full hearts) is the size of the patient’s chest, so those with smaller chests aren’t good candidates, especially women. Patients who have heart surgery are already weakened by advanced heart failure and have poor organ perfusion, thus increasing the risks of a cardiac heart transplant. In addition to surgery, patients are prescribed aggressive immunosuppressive therapies they must take to prevent transplant rejection. Restoration of normal cardiac function and good organ perfusion gradually improves the physiological state and allows the patient to progressively recover and regain their exercise capacity.

Immunosuppression is slowly decreased, while rejection is monitored using cardiac biopsies, until a baseline level of immunosuppression is reached. The immunosuppressive treatment is continued for life. A transplant patient receives ongoing follow-up care for the rest of their lives, starting with invasive procedures such as cardiac biopsies during the first year after the transplant, followed by echocardiography. The coronary arteries are also checked every two to three years. Immunosuppressive therapy is monitored by regular blood tests, usually monthly. Immunosuppressants sometimes cause undesirable and/or toxic effects that may require specific treatment and/or follow-up. The most common are high blood pressure, requiring patient to take additional medications, and renal toxicity that accumulates over time, which may require monitoring of kidneys as renal function changes.

Some long-term heart transplant patients may receive a secondary kidney transplant following kidney failure due to the toxicity of anti-rejection medications. Follow-up with a dermatologist is necessary because anti-rejection medications can create skin lesions, exacerbated by sun exposure. Follow-up with a gynecologist, including regular mammograms, is essential to detect possible carcinological complications that may be aggravated by immunosuppressive drugs. Osteoporosis should also be carefully monitored when taking corticosteroids, which are included in basic immunosuppression therapy. In women of childbearing age, contraception is required and synthetic estrogens are contraindicated. Traditional immunosuppressants are teratogenic drugs that may cause fetal malformations. Pregnancy is not necessarily contraindicated, but should be discussed in advance with your medical team. You’ll also need to have a pre-conception reassessment.

The psychological dimension of a transplant, including its impact on the family, intimate and professional spheres, must also be considered. Psychological care is offered after surgery. You may be able to go back to work after six months to a year, depending on your occupation. Regular exercise is strongly encouraged. While a heart transplant requires regular medical follow-up and drug therapy that can cause side effects, it can enable you to get back to a normal life that includes work, exercise and new projects that you may have put on hold due to heart disease.

 

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