What Happens During a Heart Transplant: Inside the Operating Room

A heart transplant is one of the most complex and life-saving procedures in modern medicine. For patients, though, it often feels like a mystery—what actually happens when you're taken into the operating room?

In this blog, I’ll walk you through the entire process—step by step, with clarity, seriousness, and reassurance. Because the more you understand, the less you fear.

Before the Surgery: The Call That Changes Everything

When a donor heart becomes available, you will get “the call.” This means:

• The donor heart is a match for your blood type and body size.

• Your transplant team believes it’s viable and safe for you.

• You’ll need to reach the hospital as soon as possible—often within 4–6 hours.

Once admitted, the team begins immediate pre-operative preparation:

• Repeat blood tests, ECG, and chest X-ray.

• Cross-match tests to confirm final donor compatibility.

• Start immunosuppressive medications to prevent rejection.

• Surgical site cleaning and anesthesia clearance.

You’ll meet your surgical team one last time. It’s normal to feel anxious, but remember: you are surrounded by experts trained for this exact moment.

Inside the Operating Room: Step-by-Step

A heart transplant usually takes 4–6 hours, sometimes more depending on complexity. Here’s what happens:

1. General Anesthesia

You’re placed under deep anesthesia. A breathing tube is inserted, and machines take over your breathing and vital monitoring.

2. Opening the Chest (Median Sternotomy)

The surgeon carefully divides the breastbone (sternum). The ribcage is gently separated to access the heart.

3. Placing You on a Heart-Lung Machine

A cardiopulmonary bypass machine takes over the work of your heart and lungs, keeping blood and oxygen circulating.

4. Removing the Diseased Heart

Most of your failing heart is removed, except the back portion of the left atrium. This remaining part will connect to the donor heart.

5. Implanting the Donor Heart

The donor heart—preserved and transported under strict conditions—is stitched into place:

• Left atrium connected.

• Right atrium connected.

• Pulmonary artery and aorta attached.

6. Restarting the New Heart

Sometimes the donor heart begins beating spontaneously. If not, a small electric shock is used to restart it.
At this moment, a new life begins.

7. Coming Off the Bypass Machine

As soon as the new heart is stable, the bypass machine is gradually turned off.

8. Closing the Chest

The breastbone is wired together, muscles and skin are closed, and a sterile dressing is applied.
Drain tubes are placed to remove excess fluid, and pacing wires may be inserted temporarily.

Immediately After Surgery

You are transferred to the Cardiac ICU (Intensive Care Unit).

Here’s what to expect:

• You’ll remain sedated and on a ventilator for several hours.

• Continuous monitoring of heart rhythm, blood pressure, oxygen, and fluids.

• Immunosuppressive drugs are started to prevent rejection.

• Your family is updated frequently.

The first 48–72 hours are critical, but your team is watching every detail closely.

Common Questions Patients Ask

Will I feel pain?
No pain during surgery (you’ll be asleep). Afterward, pain is controlled with medication.

What is the success rate?
In experienced centers, more than 90% of patients survive the first year. With proper care, many live 10–20 years or more.

Will I remember anything?
No. You will not remember the surgery itself.

What I Tell My Patients

A transplant is not just replacing a heart—it’s restarting your life.

But success doesn’t end in the OT (operating theatre). It begins there. Surgery gives you the chance. Your discipline, follow-up, and mindset after surgery will determine how well your new heart serves you.

In Summary

During heart transplant surgery:

• Your failing heart is carefully removed.

• A donor heart is connected with precision.

• The heart is restarted and monitored.

• You are supported until your body stabilizes.

It’s a complex, high-stakes surgery—but with life-changing rewards.
This is not the end of the road. It’s a new beginning.