Heart failure, this “end-of-the-life challenge” of heart function, sometimes pushes the patient to the edge of a heart transplant. At a time when traditional treatments are difficult to contain the progress of heart failure, heart transplants are as bright as a light in the dark, offering hope for rebirth. However, this major operation involves a number of complex and critical concerns, both for the patient and for the family, which require in-depth knowledge to be able to cope.
i. Pre-operative preparedness: laying the foundations for rebirth
1. Comprehensive body assessment: A heart transplant is by no means unusual and a thorough, detailed and in-depth pre-operative assessment of the patient ‘ s body is the first prerequisite for success. This assessment covers several important systems and organs. In the case of the cardiovascular system, a precise determination of the indicators of the cardiovascular function, such as heart-shot blood fractions, is required to understand the capacity of the heart to pump blood; and an assessment of the condition of the vessel to see if there is a coronary aneurysm, an exterior vascular disease, etc., as these problems may affect the operation and the blood supply of the post-operative heart. Respiratory system testing is also essential, and lung function tests allow for the determination of a patient ‘ s respirative capacity, and chest X-rays or CT can screen for lung infections, fibrosis, etc., to ensure that post-operative lungs provide adequate oxygen support to the new heart. Hepatal and renal function screening is like a “barometer” of physical metabolism and detoxification, which, in the event of poor liver and renal function, may affect the metabolic and excretion of post-operative drugs and increase the risk of drug toxicity. In addition, the assessment of the immune system is essential to provide a basis for finding an appropriate supplier ‘ s heart by, inter alia, testing human white cell antigen (HLA) formulations, while also helping to predict the risk of post-operative immune exclusion. For example, in cases of severe lung infections or liver and kidney failure, the conditions for considering a heart transplant must be met by active treatment, subject to stabilization or improvement.
2. Psychological construction and social support: Faced with the major choice of heart transplantation, patients are often surrounded by complex emotions, anxiety, fear, uncertainty about the future. Thus, pre-operative psychological construction is like a “strength needle” in the heart of the patient. Doctors, family members and professional psychologists should communicate with patients in an open and in-depth manner, explaining in plain and understandable terms the general course of the operation, the risks that may be faced and the long-term rehabilitation process. Sharing success stories allows patients to draw strength and confidence from the experiences of others, as a beacon of hope in darkness. At the same time, building strong social support networks is also a key link. Family members should give the patient constant care and support, take care of her/his life, and provide psychological encouragement and support. Friends can also visit in due course to bring warmth and joy to the patients. In addition, some patient support organizations or community-based care groups are able to provide a platform for patients to support each other, encourage each other in a climate of mutual compassion, and enhance their psychological resilience to meet surgical challenges with a better mindset.
3. Management of the waiting period: For patients requiring a heart transplant, the process of waiting for a suitable supply is fraught with suffering and uncertainty. During this period, patients are required to follow the doctor ‘ s treatment programme and actively control the symptoms of heart failure. Medicinal treatment is a core tool, and sodium sodium is usually used to reduce the burden of sodium in the heart, e.g., fursermi; an vascular stressor (ACEI) or an vascular stressor II receptor (ARB) is used to improve cardiac reconstruction, e.g., Inapli, Zoltan, etc.; beta receptor retardants can reduce the heart rate and myocardial oxygen, e.g., Metolore, etc.; lysergone is used to further regulate hydrolytic balance, e.g., propene. Patients must take these drugs on time and on time, and must not reduce their own volume or stop them. At the same time, the way of life is in no way relaxed. Strictly following the principle of low-salt diet, daily salt intake is controlled at 3 – 5 grams, reducing the intake of high-salt foods such as pickles, pickles, etc., to reduce the heart burden; low fat diets reduce blood resin levels and prevent the further development of cardiovascular diseases and avoid the consumption of high-fat foods such as animal fats and fried foods; and adequate physical exercise, such as simple indoor walks, Tai Chi, etc., helps to increase the resilience and resistance of the body, but care to avoid overwork. Periodic visits to the hospital for review, including cardiac function checks, blood tests etc. The doctor adjusts the treatment programme in a timely manner based on the results of the examination to ensure that the patient remains in a relatively stable physical state while waiting for the supply.
II. THE ELEMENTS OF THE PROCEEDINGS:
1. Anaesthesia and in vitro cycling: cardiac transplants require a full-scale anesthesia, which requires an anesthesiologist with high professional skills and extensive experience. During anaesthesia, precise control of the type and dose of anaesthesia is required and the vital signs of the patient, such as heart rate, blood pressure, breathing, blood oxygen saturation, etc., are closely monitored to ensure that the patient is in a safe and stable state of anaesthesia during surgery. At the same time, in vitro cycling is an important support for heart transplants. In vitro cycling machines are like an “artificial heart lung” that temporarily replaces the heart and lung function, and in the course of the operation they induce the patient’s intravenous blood, which is then pumped back into the artery system after oxidation and filtration, to maintain the entire blood circulation and oxygen supply. This process requires close collaboration between in vitro cycling teams, strict control of parameters such as blood flow, temperature, pressure, ensuring a smooth in vitro cycling, and providing a clear and stable surgical vision and operating time for the surgeon, as in the case of a “temporary bridge” for life when the heart stops beating.
2. Supply heart implants: The operation moves into the most critical supply heart implants when the right supply reaches the operating room. The surgeon is required to quickly and carefully connect the supply heart to the patient ‘ s original cardiovascular system with a high degree of precision and skill. This process is like a fine “heart suture” contest, which needs to be completed in the shortest possible conditions of temperature and blood deficiency. First, the left-heart of the supply heart is matched with the patient ‘ s left-heart to ensure a smooth flow of blood back to the heart; then, in turn, the aorta and pulmonary artery are matched so that the blood of the heart can be pumped out and the whole body supplied. Each stitch requires precision, and a slight deviation could lead to serious complications such as post-operative cardiac abnormalities, haemorrhaging or vascular narrowness. Throughout the implantation process, there is a need to maintain a high degree of harmony among the members of the surgical team, as a “life team” that works closely together to ensure that the heart of the supplier can quickly and perfectly “settle home” within the patient and re-open the rhythm of life.
III. Post-operative rehabilitation: safeguarding the hopes of new generations
1. Serious care and vital signs monitoring: After the operation, the patient is sent to the ICU for close observation and care. Within the ICU, the patient will be subject to continuous and close monitoring of vital signs such as heart rate, blood pressure, breathing, body temperature, blood oxygen saturation, etc., as a “life treasure” that is fully guarded. Various advanced monitoring equipment, like “lifeguards”, remain vigilant to any possible anomalies. On the basis of these monitoring data, medical personnel adjust treatment programmes in a timely manner, such as adjusting the doses of vascularly active drugs to maintain blood pressure stability and using respirator-aided breathing to ensure adequate oxygen supply. At the same time, close attention will be paid to the patient ‘ s heart function indicators, such as cardiac ultrasound to assess the constriction and convulsion of the heart, EKG to monitor the normal pace of the heart. In addition, the observation of the patient ‘ s state of consciousness, urine, etc., is an important component, and these indicators reflect the overall physical condition of the patient and the infusion of organs and provide an important basis for the timely detection and treatment of post-operative complications.
Immunosuppression treatment and exclusion response monitoring: After heart transplants, the patient’s immune system treats the newly implanted heart as an “imogenous object” and attempts to launch an attack, so immunosuppression treatment becomes a key component of post-operative treatment. Patients need to take long-term immunosuppressants, such as cyclothylene, takmos, cyphenate, etc., as if they were wearing a “immunoprotective coat” for the new heart, inhibiting the activity of the immune system and reducing the risk of exclusion. However, the use of immunosuppressants also poses a number of risks, such as increased susceptibility to infection and increased risk of tumours. As a result, the patient is required to take the medication strictly in accordance with the time limits prescribed by the doctor, and no increase in the volume of the drug may be made or taken off. At the same time, there is regular monitoring of immunization functions and drug concentrations, and doctors adjust drug doses to the results to ensure the effectiveness and safety of immunosuppressive treatment. In addition, the monitoring of exclusionary responses is a top priority. Patients are required to undergo regular myocardial biopsy, which is the “gold standard” for the diagnosis of exclusion. Through myocardial biopsy, doctors are able to observe directly the pathological changes in the heart tissue and determine whether there is an exclusionary reaction and the severity of the exclusionary response. If an exclusionary response is found, the immunosuppressive treatment programme can be adjusted in a timely manner to increase the dose of the drug or to replace the drug type, as is the delicate balance between the immune system and the new heart, ensuring that the new heart can survive in the patient in the long term with stability.
Rehabilitation and long-term follow-up: as the physical condition stabilizes, the patient will be transferred from the ICU to the general ward to begin the post-operative rehabilitation journey. The process of rehabilitation is gradual and sustained. At an early stage, patients can carry out simple physical activities in their beds, such as flipping, hand-lifting and leg-lifting, which appear to be like “rehabilitating buds”, which help to promote the blood cycle and prevent the formation of haemorrhages and muscle atrophy. Under the guidance of the medical staff, there has been a gradual increase in activity, such as sitting, standing by the bed and walking at short distances. With regard to diets, the principle of nutritional enrichment and digestivity is to be followed in the early post-operative stages, with a gradual transition to a balanced diet. Ingestion of proteins, such as skinny meat, fish, eggs, pulses, etc., should be increased to promote physical recovery; adequate intake of vegetables and fruit to ensure the availability of vitamins and dietary fibres; and control of fat and salt intake to reduce the heart burden. At the same time, care must be taken to maintain good living habits, such as the cessation of alcohol and alcohol, regularity and the avoidance of excessive labour. Long-term follow-up visits are an important component of post-operative management for heart transplant patients, as is the “guarding” of health. Patients are required to visit the hospital on a regular basis for review, including for heart function, immunological function, blood biochemical examination, drug concentration monitoring, etc. On the basis of the results of the review, the doctor assesses the patient ‘ s state of health, adjusts the treatment programme and promptly identifies and treats possible complications such as cardiac vascular disease, infections, tumours, etc. In addition, patients with any symptoms of discomfort in their daily lives, such as fever, inactivity, panic, short-temperature, cough, etc., should be provided with immediate medical treatment to ensure timely diagnosis and treatment.
A heart transplant with heart failure is a “life-and-death battle” with fate, a “protection net” for life and hope, made up of careful preparation before the operation, precision in the operation and care and follow-up after the operation. It is only when patients and their families are fully and thoroughly aware of and adhere to these concerns that the final victory on this challenging journey can be achieved, with a new heart beating strongly inside the body, opening a new and wonderful chapter of life and a renewed light of hope.
