About 10 percent of the more than 6 million Americans living with heart failure have advanced heart failure – stage D, according to the American Heart Association and American College of Cardiology’s A-to-D staging system. Advanced heart failure treatment is complex, involving the implantation of devices or, when all other treatments are no longer effective, heart transplantation, a surgical procedure that replaces a diseased or defective heart with a healthy heart from a donor.

Since performing the first heart transplant at the Heart & Vascular Institute at Memorial Hermann-Texas Medical Center in 2012, physicians affiliated with the Institute’s Center for Advanced Heart Failure (CAHF) have created one of the fastest-growing transplant programs in the U.S.

Detailed data about the program is available from the Scientific Registry of Transplant Recipients.

World-Renowned Heart Transplant Team

At CAHF, a joint collaboration between the Memorial Hermann Heart & Vascular Institute and the McGovern Medical School at UTHealth, patients with advanced heart failure are treated by a dynamic, multidisciplinary advanced heart failure team of highly skilled, board-certified physicians whose are specialists in cardiothoracic surgery, advanced heart failure, mechanical assist devices, video-assisted surgery, high-risk coronary intervention and heart transplantation.

The team is led by cardiothoracic and vascular surgeon Igor Gregoric, MD, professor at McGovern Medical School and chief and program director of the Surgical division of the CAHF, and cardiovascular disease specialist Biswajit Kar, MD, professor of Medicine at McGovern Medical School and chief of the Medical division of the CAHF. Collectively, they have over 50 years of experience in heart transplantation and ventricular assisted devices (VADs), have published well over 400 research/publications and have given hundreds of International presentations on the topics of advanced heart failure and transplantation.

These affiliated physicians serve as principal investigators in national and international research trials, giving patients access to new medical therapies, innovative devices and technologies very quickly after their introduction. Patients who qualify have the opportunity to participate in clinical trials of treatments not otherwise available.

Heart Conditions That May Require Transplant

The following are common diseases or conditions which, may necessitate a heart transplant.

Coronary Artery Disease

Coronary artery disease, also known as coronary heart disease, is the most common form of heart disease in the U.S. and the No. 1 killer of men and women in this country. It occurs when fatty deposits, or plaque, build up in the coronary arteries, which supply oxygen-rich blood to the heart. This accumulation of plaque thickens and narrows the arteries, decreasing or blocking the flow of blood to the heart. Coronary artery disease develops over time, so people usually do not experience symptoms until after age 50. Reduced blood flow to the heart can cause chest pain or shortness of breath. A heart attack occurs when blood supply is completely blocked. Risk factors include family history, high blood pressure, high cholesterol, diabetes, sedentary lifestyle, obesity, smoking and stress.

Cardiomyopathy

Cardiomyopathy occurs when the heart muscle becomes enlarged, thickened or rigid (and thus weakened), potentially causing dangerous arrhythmias (irregular heartbeats) or heart failure. Symptoms of heart failure may include shortness of breath; fatigue; dizziness; light-headedness; swelling of the ankles, legs, feet, abdomen or veins in the neck; fainting during physical activity; chest pain, especially after physical exertion or heavy meals; or heart murmurs, extra or unusual sounds heard during a heartbeat.

  • Dilated cardiomyopathy (DCM) is the most common type of cardiomyopathy and typically occurs in middle-aged and older adults. It is a progressive, usually irreversible, disease that occurs when the heart’s main pumping chamber, the left ventricle, becomes enlarged, inhibiting the heart’s ability to pump blood, weakening the heart and ultimately causing heart failure. DCM can also lead to heart valve problems, arrhythmias and blood clots in the heart. According to the American Heart Association, up to one third of people with DCM inherited it from their parents, but it can also be caused by coronary heart disease or heart attack, metabolic disorders (such as diabetes or thyroid disease), HIV and other viruses, chronic alcoholism, exposure to certain toxins, drug use or abuse, certain cancer medications or complications in pregnancy.
  • Restrictive cardiomyopathy typically affects older adults and occurs when the heart muscle becomes rigid and less elastic. Over time, blood flow in the heart is reduced, leading to problems such as arrhythmias or heart failure. Restrictive cardiomyopathy can be idiopathic (of unknown cause) or can result from hemochromatosis, a condition in which iron builds up in the heart; sarcoidosis, a condition that causes inflammation and can cause lumps of cells to grow in the heart and other organs; amyloidosis, a disease in which abnormal proteins build up on the body’s organs, including the heart; connective tissue disorders and some cancer treatments, such as radiation and chemotherapy.
  • Hypertrophic cardiomyopathy (HCM) is characterized by a thickening of the heart muscle, particularly the left ventricle, which makes the inside of the left ventricle smaller, restricting the amount of blood it holds. HCM can raise the blood pressure in the ventricles and in the blood vessels in the lungs and may disrupt the heart’s electrical signals causing arrhythmia. People of any age may be affected by HCM, especially people with a family history of the disease. Symptoms can range from nonexistent to severe.

Heart Valve Disease

Heart valve disease, also called valvular heart disease, occurs when one (or more) of the heart’s four valves ceases to open correctly, so that blood can empty from the chamber, and/or to close properly, so that blood cannot flow the wrong way. Many people with valve disease are unaware of their symptoms, as symptoms may develop slowly, or because they attribute their symptoms to simply being out of shape or other reasons. Symptoms may include chest pain or palpitations; shortness of breath; fatigue, weakness or inability to maintain regular activity level; lightheadedness or loss of consciousness; or swollen ankles, feet or abdomen. Heart valve disease may be caused by a narrowing (stenosis), collapsing (prolapse) or leaking (regurgitation) of the valve. Although many valve problems are age related, people with illnesses, such as rheumatic fever and infective endocarditis (infection in the lining of the heart), may be at higher risk.

Congenital Heart Disease

Congenital heart disease, also called congenital heart defect, refers to an abnormality in the structure of the heart that occurs while the fetus is developing in the uterus. The word “congenital” means the defect exists at birth. The most common type of birth defect, congenital heart defect may affect approximately one in 100 children and may be caused by generic or chromosomal abnormalities; the mother’s use of drugs, alcohol or tobacco during pregnancy; a maternal viral infection or a family history of congenital heart disease. Symptoms may appear at birth, during childhood or not until adulthood. Physicians affiliated with the Children’s Heart Institute at Children’s Memorial Hermann Hospital provide care for infants and children with congenital heart disease.

In addition, a heart transplant might be required due to failure of a previous heart transplant.

The Organ Donation Process

Life-saving heart transplantation is made possible through the generous “gifts of life” by donors who, while living, registered to become donors (upon their death), either when signing up for or renewing their driver’s licenses or through the DonateLifeTexas.org registry. If the deceased has not registered but is a candidate for donation, his or her next-of-kin can provide consent for donation on his or her behalf. Currently, 47 percent of Texans are registered donors, and there are over 100,000 individuals awaiting organ transplants in the U.S.

Upon a donor’s death, the donor’s organs and/or tissues are recovered by an organ procurement organization (OPO). The OPO serving the Greater Houston area is LifeGift.

To learn more about the organ donation process, click here.

Heart Transplantation Process

From the time a patient enters the Memorial Hermann Heart Transplant program, he or she will receive individualized care from the same multidisciplinary team of physicians, nurse clinicians, social workers, coordinators and others, to ensure continuity and quality of care. Throughout the process, referring physicians are kept informed about the patient’s progress.

Pathway to Transplantation

Patients who have severe functional impairment with no medical or surgical therapeutic options and are referred for transplantation undergo a rigorous medical, psychological and social evaluation. On the basis of this evaluation, previous medical records and psychosocial information, a decision is made by the Medical Review Board regarding the advisability of cardiac transplantation.

Patients who are considered for transplantation typically suffer from:

  • Advanced heart failure (defined as NYHA Class IIIB or IV), refractory to optimized medical therapy
  • Severe coronary artery disease with intractable angina, despite optimized medical therapy, that is not amenable to bypass surgery or angioplasty OR
  • Malignant ventricular arrhythmias that do not respond to all other accepted therapeutic modalities
  • Are generally less than 70 years old
  • Do not have multi-organ dysfunction
  • Exhibit psychosocial stability and have a supportive social environment
  • Demonstrate financial responsibility for maintenance of post-transplant medications and testing

Not all patients with advanced heart failure are eligible for a heart transplant. Generally, those who meet one or more of these criteria are not recommended:

  • 70 years of age or older
  • Suffer from another medical condition that could shorten life, regardless of receiving a donor heart
  • Have serious blockages in the arteries in arms or legs (peripheral artery disease)
  • Have a personal medical history of cancer
  • Are unwilling or unable to make lifestyle changes that are necessary to keep a donor heart healthy, including not drinking alcohol or smoking

Once transplant candidates have undergone a thorough screening process, they are placed on the national transplant list and monitored while awaiting a donor heart. If the transplant candidate’s condition begins to decline, intravenous medications, total artificial heart or ventricle assist device implantation may be recommended until a donor heart becomes available.

Heart Transplant Procedure

Once a donor heart has been identified, the patient is called to the hospital immediately, where a thorough evaluation is conducted on the donor organ and the patient.

Heart transplant is performed under general anesthesia with the patient on a bypass machine, which keeps oxygen-rich blood flowing throughout the procedure. It generally lasts four to six hours, longer if the patient has had previous coronary surgery or if there are complications. The surgeon exposes the chest cavity and opens the pericardium. The diseased heart is removed, leaving the back part of the left atrium in place. The donor heart is implanted, and the chest is closed. In some patients both heart and lungs may be transplanted during the same procedure.

Immediately after surgery, patients receive pain control medication. A ventilator is used to help a post-operative patient breathe and tubes are inserted in the chest to drain fluids from around the lungs and heart.

The post-surgery hospital stay will last one to two weeks. For about three months afterward, transplant recipients are closely monitored on an outpatient basis, including blood work, echocardiograms and electrocardiograms.

Possible Transplant Risks

Although receiving a donor heart can save a person’s life, transplantation is an open-heart surgical procedure accompanied by serious risks, the most significant of which is rejection. All heart transplant recipients receive immunosuppressants, but about one in four have some signs of rejection during the first year after surgery. Usually the rejection has no symptoms and requires only an adjustment of medications.

Short-term risks can include arrhythmia, bleeding, stroke, donor organ dysfunction, hyperacute or acute rejection, infection and kidney failure. Long-term risks can include cancer, coronary disease, chronic rejection, hypertension and infection.

Heart Transplant Recovery

A patient’s post-op care is part of the individualized treatment plan that was created for him or at her at the beginning of his or her transplant journey. Following a patient’s transplant surgery, he or she will be cared for by the same multidisciplinary team that has cared from them from the start, to ensure continuity and quality of care.

After a heart transplant, patients must make some permanent long-term adjustments, including:

  • Taking immunosuppressants, medications that reduce the activity of the immune system, to prevent the immune system from rejecting the new heart
  • Undergoing cardiac rehabilitation and making lifestyle changes, such as regular exercise and diet, that keep a transplanted heart healthy
  • Taking advantage of the emotional support services made available to them, to help them deal with the inevitable stress and changes that follow a transplant

Heart Transplant Support Groups

Transplantation can sometimes seem overwhelming for patients. We sponsor support and education groups for heart and lung transplant patients, their families and caregivers, at the Texas Medical Center location. The groups are as follows:

  • Patient and family/support persons:
    Every Tuesday from 11 a.m - 12 p.m.
    Heart & Vascular Institute at Memorial Hermann-Texas Medical Center
    5th Floor Waiting Area
    6411 Fannin Street
    Houston, TX 77030
  • LVAD/Mechanical Circulatory Support patient only:
    The second Thursday of each month from 11:30 a.m. - 12:30 p.m.
    Center for Advanced Heart Failure Clinic
    6400 Fannin Street
    Suite 2500
    Houston, TX 77030
  • Heart/Lung Transplant classes for patients and their family/support persons:
    Every Wednesday morning from 7:30 a.m. to 9:30 a.m.
    23rd floor of Medical Plaza
    6400 Fannin Street
    Suite 2350
    Houston, TX 77030

For more information, please contact Beth Mosele, LCSW, CCTSW-MCS, at (713) 704-4300.

Memorial Hermann sponsors Mended Hearts, a support group for anyone with heart disease. The Mended Hearts Support Groups are held at various Memorial Hermann hospitals throughout the Houston area.

Getting Started

To refer a patient or for additional information regarding the heart transplant program at Memorial Hermann Heart & Vascular Institute, please use our contact us form.

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