What are advanced therapies?
The gold standard for advanced heart failure is heart transplant. Unfortunately, there are not enough donors for everyone that needs a heart transplant and/or not everyone is a good candidate to receive a heart transplant. Sometimes your cardiologist may think you would benefit from a left ventricle assist device. An LVAD is a pump connected to the left ventricle and the aorta. It assists your heart by continuously pumping blood from the heart to the rest of the body.
It is important to remember that a heart transplant is not a cure; it is trading one chronic condition – heart failure – for another – heart transplant. Once you receive a heart transplant, you will have to take multiple medications and have a lifelong routine follow-up. These medications have side effects such as an increased risk for infection, increased risk for cancer, high blood pressure, high blood sugar, and high cholesterol.
How will I be evaluated?
Before starting your evaluation, your insurance company will obtain financial authorization. This can take up to 14 days. Once financial authorization is in place, someone from our team will reach out to you to find dates to schedule your evaluation. You will be scheduled for numerous tests, blood work, and appointments to meet the heart transplant team. This process usually takes three to five days. It is usually done as an outpatient, but sometimes your doctor may think you are sick enough that it’s done while you are in the hospital. Your first appointment for the evaluation will be with a transplant coordinator to review the process in depth and to sign the acknowledgment forms given to you in this packet. Signing these forms says that you understand the evaluation and listing process, have read the forms and have had the opportunity to ask questions. Signing the forms does NOT mean you will be listed for transplant or will receive an LVAD.
- Blood testing
- Blood and tissue typing
- Drug or tobacco screen
- Electrocardiogram (EKG)
- Cardiopulmonary stress test
- Pulmonary function tests
- 6-minute walk
- Abdominal ultrasound
- Chest CT scan
- Vascular doppler studies
- Bone density scan
- Dental exam, including X-ray
A heart transplant evaluation process includes much more than physical health. A financial counselor will meet with you as a part of your evaluation to provide you with additional information and comfort. You will also meet with a Pharmacy financial counselor to discuss your insurance coverage and benefits, learn about potential medications and their costs, and review any concerns you and your family may have.
We also include a psychological evaluation as part of this process to ensure a heart transplant is the right treatment option available. The evaluation will help determine whether you can comply with the necessary treatment regimen before and after the transplant.
Once the evaluation is complete, your case your cardiologist will present your case to the committee for recommendations. Those recommendations could be:
- List for heart transplant
- LVAD as a bridge to transplant
- LVAD as destination therapy
- Continue medical therapy
- Supportive care
Once a decision is made, a heart transplant coordinator will call you to review the outcome. If you are listed for heart transplantation, certain expectations are required. You will need to be seen by a Nebraska Medicine heart transplant cardiologist every three months, which will also include lab work and testing.
When am I placed on a waiting list for a heart transplant?
Before placing you on a waiting list for a heart transplant, we want to make sure there is no other treatment option available for your condition. We must be fully confident that you can endure the transplant process.
You will be notified when you are placed on the heart transplant list. The following is an example of a listing on the heart transplant list. Status is based on medical urgency with six main classifications. Below is a general, simplified explanation of the statuses:
- Status 1: Includes critically ill patients in the hospital requiring mechanical support with a temporary pump
- Status 2: Includes patients in the hospital requiring mechanical support that is less than required for status 1, hospitalized patients with ongoing ventricular arrhythmias
- Status 3: Includes patients on high-dose inotropes in the hospital, LVAD complications, discretionary “30-day” time for LVAD patients
- Status 4: Includes patients with congenital or restrictive heart disease, ischemic disease with intractable angina, in need of re-transplant, stable LVAD or on home inotropes
- Status 5: Dual organ transplant (heart+kidney, heart+liver)
- Status 6: Patients who do not meet the criteria for status 1 through 5
Your status can vary based on your health and will be monitored closely by the transplant team. For more information on these statuses and the waitlist, visit www.unos.org or ask your transplant coordinator.
What happens when your healthy heart arrives?
As soon as we are notified that a healthy heart is on its way to Nebraska Medical Center, our transplant surgeons prepare to remove your diseased heart. When the new heart arrives, you will be connected to the heart-lung machine, which will take over the function of the heart and lungs for the rest of the procedure.
After the diseased heart is removed and your healthy heart is attached, surgeons connect the blood vessels, allowing blood to flow through the heart and lungs. Surgeons check all the connected blood vessels and heart chambers for leaks before removing you from the heart-lung machine. The heart-lung device is turned off, leaving the new heart to work by itself.
Keep in mind there are always risks and potential complications with surgery. A patient may bleed more than usual, get an infection, have trouble breathing, get blood clots, or the body may reject the heart. Our team will monitor you closely following surgery and treat any of these complications.