From the holding area, you will be taken to the operating room where the procedure will actually take place. The room will feel cool. You will lie on a table and you will be connected to equipment that will monitor your heart rhythm, blood pressure, and oxygen levels. A probe will be placed on your finger or ear lobe to constantly monitor your oxygen levels.

Once you are in the operating room, the anesthesiologist or anesthetist will give you medication in your IV to sedate you. Once you are sedated, a breathing tube will be inserted through your throat into your lungs and you will be connected to a ventilator, which will breathe for you during the surgery. A tube will be inserted through your mouth into your stomach to drain your stomach fluids. A special IV will be placed into an artery in your wrist and connected to a monitor in order to monitor your blood pressure during the procedure. In addition, blood will be drawn from this special IV, called an arterial line, to check the oxygen levels in your blood during the operation.

Another special type of IV will be inserted into your neck and connected to a monitor so that your heart's status can be closely monitored during and after the procedure. This neck IV is called a pulmonary artery catheter, because the tip of it is in the pulmonary artery.

You will lie flat on your back during the entire procedure. The operating room is a sterile area, so everyone in the room will wear gowns, masks, and caps. The physician and assistants actually performing the procedure will wear sterile gloves.

Anesthesia

You will be kept sedated during the operation and will not be aware of anything until two to three hours or more after the procedure has been completed.

Basic description of the procedure

• Once all the preparations have been completed in the holding area, you will be taken by stretcher into the operating room.
• The anesthesiologist or anesthetist will give you medication in your IV to sedate you.
• Once you are sedated, a breathing tube will be inserted through your throat into your lungs and connected to a ventilator, or breathing machine. The ventilator will breathe for you during the procedure by moving oxygen and air in and out of your lungs.
• An arterial line will be inserted into your wrist so that your blood pressure can be monitored during the surgery. Blood samples will be drawn from the arterial line periodically during the procedure to check the oxygen levels in your blood.
• A pulmonary artery catheter will be inserted into a vein in your neck to help monitor your heart function during and after the procedure.
• A catheter will be inserted into your bladder to drain urine during and after your procedure.
• The heart surgeon makes an incision (cut) down the center of the chest from just below the Adam's apple to just above the navel.
• The sternum (breastbone) is sawed in half with a special operating instrument. The surgeon then separates the two halves of the breastbone and spreads them apart to expose the heart.
• Tubes are inserted into the chest so that the blood can be pumped through your body by a cardiopulmonary bypass machine.
• Once the blood has been completely diverted into the bypass machine for pumping, the diseased heart is removed.
• The donor heart is sewn into place. Once the new heart is in place, blood vessels are connected.
• When the transplant procedure has been completed, the blood circulating through the bypass machine will be let back into the heart and the tubes to the machine removed. The heart will be shocked with small paddles to restart the heartbeat.
• Once your new heart begins to beat again, the surgeon will observe the heart to assess the function of the heart and to make sure there are no leaks where the blood vessels are connected.
• Temporary wires for pacing may be inserted into the heart. These wires can be attached to a pacemaker box and your heart can be paced, if needed, during the initial recovery period.
• The sternum will be pushed back together and sewn together with small wires.
• The skin over the sternum will be sewn back together.
• Tubes will be inserted into your chest to drain blood and other fluids from around the heart. These tubes will be connected to a suction device to keep fluids pulled away from the heart.
• You will be transferred from the operating table to a bed, then taken to the ICU.

Procedure time

The procedure will take about three to six hours, depending on the complexity of the procedure.