Heart Transplant: Initial Postoperative Care and Where the Field Is Heading (Podcast)

The number of heart transplants has increased over the past few years both nationally and at Cleveland Clinic, owing to an expanded supply of donor hearts due to growing prevalence of donation after circulatory death and improved organ preservation technology.

That means more opportunities to offer heart transplantation to patients in need, and thus more reason for referral for transplant evaluation for potentially appropriate candidates. “Our philosophy about evaluation is ‘the sooner, the better’,” says Cleveland Clinic heart failure cardiologist Sanjeeb Bhattacharya, MD. “Even if a referring cardiologist feels like their heart failure patient is still doing OK, it’s best to have that touch point early on. Hopefully I can tell the patient, ‘You’re doing well; see your cardiologist more frequently and then I can see you maybe once a year or every other year until things get a bit worse, if they do.’ In general, earlier is very much better.”

Referral considerations are just one of the issues explored by Dr. Bhattacharya and his colleague Michael Tong, MD, Director of Cardiac Transplantation and Mechanical Circulatory Support, in a recent episode of Cleveland Clinic’s Cardiac Consult podcast. The two physicians begin by discussing best practices in patient care during the first year after transplantation and move on to advancements in transplant-related technologies, organ supply and collaborative care approaches. Along the way they address the following:

• Tailoring immunosuppression strategies to individual patient risk
• Post-transplant biopsy and monitoring
• Vaccinations and infection prophylaxis before and after transplant
• Advising patients on postoperative activity and return to work
• Donor pool expansion and technologies for assessing donor hearts for use
• Advances in LVAD use and transplant allocation
• Transplant in congenital heart disease patients and other complex cases

Click the podcast player above to listen to the 21-minute episode now or read on for an edited excerpt. Check out more Cardiac Consult episodes at clevelandclinic.org/cardiacconsultpodcast or wherever you get your podcasts.

Excerpt from the podcast

Michael Tong, MD: Another important development is that we’re able to do transplants in more and more complex patients. Patients that we wouldn’t transplant even just 10 years ago are able to be taken on with no real problem now.

One such area that you specialize in are patients with congenital heart conditions, especially those who have reached adulthood and may have had a Fontan procedure early in life. These are patients who are now reaching their 30s and 40s and their Fontan operations are failing. We have been doing transplants in these patients more and more often now, with excellent outcomes. Talk a bit about how we can help provide care for these types of patients.

Sanjeeb Bhattacharya, MD: Yes, this is a patient population that’s increasingly coming. They're in their 20s and 30s, sometimes older, and they are starting to have issues, whether they have single-ventricle physiology and are developing signs of Fontan failure or they have a complex dual-ventricle physiology and start having worsening ventricular function or regurgitation.

Historically, these individuals would not be considered great candidates for transplant because there is a lot going on with these patients, certainly from a medical standpoint and sometimes from social standpoint and other standpoints as well. But we have a very good multidisciplinary team approach — including our surgical colleagues, pediatric surgical colleagues, congenital heart disease colleagues, pediatric cardiologists, social workers, dietitians and others — that has really helped us care for these patients in two key ways. First, by identifying these patients and seeing that we can do something for them, and second by ensuring tailored management of them in the pretransplant, transplant and post-transplant periods.