Heart transplant surgery begins with a major incision down the chest and the splitting in half of the breastbone, according to the University of California San Francisco Medical Center. Next, the doctor connects the patient's main arteries to a heart and lung bypass machine and removes most or all of the damaged heart, replacing it with a healthy donated heart. Finally, the incisions are closed.
The majority of heart transplants are done via orthotopic surgery, and heart transplant surgery is considered less complicated than most heart bypass surgeries, explains the UCSF Medical Center. In an orthotopic surgery, the atria, or back half of both upper heart chambers, are left intact when the majority of the heart is removed. After removal, the front half of the new heart is sewn into the back half of the existing heart via the donor's pulmonary arteries and aorta. The bypass machine is then disconnected so the new heart can pump blood on its own.
Prior to surgery, clothing and jewelry are removed, an intravenous line is started to administer necessary fluids, and a catheter is inserted into the bladder to control urine flow, advises Johns Hopkins Medicine. Additional catheters are inserted into the wrist and neck to monitor blood and heart pressure, as well as getting blood samples. The surgery is performed under general anesthesia and may require a hospital stay of up to 14 days or more.