Transplant and Pulmonary Hypertension
During Transplant – Overview of the Surgical Procedure
Once you have received the call, arrived at the hospital, gone through the pre-operative workup and the donor lungs have been established as being suitable for transplant, you will be moved to the operating room. There, you will undergo general anesthesia (be put to sleep) and will be placed on a ventilator and bypass machine in order to deliver oxygen to your blood while the transplant is taking place. Patients typically spend 5–9 hours in the operating room and remain in the hospital for 14–18 days.
Four different types of lung transplants are available to PH patients:
- For a single-lung transplant, an incision is made below your shoulder blade and along the side of your chest. The surgeon removes your old lung and sews the new lung in place, connecting the blood vessels to and from the lung and the main airway. At the end of the operation, the surgeon brings the ribs back together and closes the incision.
- For a double-lung transplant, an incision is made across the middle of your chest, under your breasts, from one underarm to the other. The surgeon partially divides the breastbone and enters the chest cavity between the ribs. The surgeon removes the lung on one side and sews the new lung in place, and then does the same on the opposite side. At the end of the operation, the surgeon wires the breastbone together, brings the ribs back in place, and closes the incision.
- For a heart-lung transplant, an incision is made down the middle of your chest. The surgeon removes your old heart and lungs, leaving a “cuff” of the atrium and the end of the main airway to provide a place to attach your new organs. The surgeon also sews your aorta (the main blood vessel leading to your body) to the aorta of the donor heart. At the end of the operation, the surgeon wires your breastbone together and closes the incision.
- For a lobar transplant from living donors, three operations must be performed simultaneously. In two operations, doctors remove the lower lobes of the lungs from the two donors. The third operation typically involves removing both lungs in the recipient and replacing them with the donors’ lobes.
Most patients wake up two to 10 hours after their surgery is finished. Patients often report that they remember no pain from the actual operation. When you awaken in the intensive care unit (ICU), you will have what patients call a “zipper” on your chest. The location of this new scar depends on the type of transplant you had; it might be down the center of your chest, across your chest just under the breasts or off to one side.
What to Expect After Surgery
When you wake up after surgery, you will find an assortment of tubes and monitoring equipment on your body. You may also experience a number of symptoms after surgery and in the weeks following including pain, nausea, weakness and increased heart rate. Most patients are able to walk by the third or fourth day after they enter the ICU. You will be continuously monitored and may require a week, a month or more to recover. The recovery process involves a combination of chest physiotherapy (CPT), exercise and proper nutrition. Learn more about what to expect after surgery