question: How is a person kept alive during a heart transplant, where the old heart is out, but the new heart isn’t in yet?
comment: Your heart is just a pump that moves blood around your body. Surgeons have a machine with a pump called a "Heart Lung Bypass" that they install to keep blood moving around while they work.
passages: In people with cystic fibrosis (CF), where both lungs need to be replaced, it is a technically easier operation with a higher rate of success to replace both the heart and lungs of the recipient with those of the donor. As the recipient's original heart is usually healthy, it can then be transplanted into a second recipient in need of a heart transplant, thus making the person with CF a living heart donor. In a 2016 case at Stanford Medical Center, a woman who was needing a heart-lung transplant had cystic fibrosis which had led to one lung expanding and the other shrinking thereby displacing her heart. The second patient who in turn received her heart was a woman with right ventricular dysplasia which had led to a dangerously abnormal rhythm. The dual operations actually required three surgical teams including one to remove the heart and lungs from a recently deceased initial donor. The two living recipients did well and in fact had an opportunity to meet six weeks after their simultaneous operations.
   BULLET::::- In July 2009 in England, surgeons removed a donor heart that had been implanted in a toddler next to her native heart, after her native heart had recovered. This technique suggests mechanical assist device, such as an LVAD, can take some or all the work away from the native heart and allow it time to heal.
  
  BULLET::::- In July 2009, 18-month follow-up results from the HeartMate II Clinical Trial concluded that continuous-flow LVAD provides effective hemodynamic support for at least 18 months in patients awaiting transplantation, with improved functional status and quality of life. (see below).
   The patient is connected to a heart–lung machine, which circulates and oxygenates blood. The surgeon removes the failing heart and lungs. Most surgeons endeavour to cut blood vessels as close as possible to the heart to leave room for trimming, especially if the donor heart is of a different size than the original organ.
   "Heart transplantation" is performed on patients with end-stage heart failure or severe coronary artery disease. The most common procedure is to take a working heart from a recently deceased organ donor (allograft) and implant it into the patient. The patient's own heart may either be removed (orthotopic procedure) or, less commonly, left in to support the donor heart (heterotopic procedure). It is also possible to take a heart from another species (xenograft), or implant a man-made artificial one, although the outcome of these two procedures has been less successful in comparison to the far more commonly performed allografts.
  
  Section::::Main organs.:Lung.
   On 12 March 2011, an experimental artificial heart was implanted in 55-year-old Craig Lewis at The Texas Heart Institute in Houston by O. H. Frazier and William Cohn. The device is a combination of two modified HeartMate II pumps that is currently undergoing bovine trials.
  
  Frazier and Cohn are on the board of the BiVACOR company that develops an artificial heart. BiVACOR has been tested as a replacement for a heart in a sheep.
   BULLET::::9. The heart is restarted by removing the aortic cross clamp; or in "off-pump" surgery, the stabilizing devices are removed. In cases where the aorta is partially occluded by a C-shaped clamp, the heart is restarted and suturing of the grafts to the aorta is done in this partially occluded section of the aorta while the heart is beating.
  
  BULLET::::10. Once the grafts are completed distally and proximally, the patient is rewarmed to a normal temperature and the heart and other pressures are normal to support coming off the bypass machine, weaning off the bypass machine begins.
   A heart transplant, or a cardiac transplant, is a surgical transplant procedure performed on patients with end-stage heart failure or severe coronary artery disease when other medical or surgical treatments have failed. , the most common procedure is to take a functioning heart, with or without transplanting one or both lungs at the same time, from a recently deceased organ donor (brain death is the standard) and implanting it into the patient. The patient's own heart is either removed and replaced with the donor heart (orthotopic procedure) or, much less commonly, the recipient's diseased heart is left in place to support the donor heart (heterotopic, or "piggyback", transplant procedure).
   The patient is connected to a heart-lung machine, which circulates and oxygenates blood. The surgeon removes the failing heart and lungs. Most surgeons endeavour to cut blood vessels as close as possible to the heart to leave room for trimming, especially if the donor heart is of a different size than the original organ.
   In the early 1990s, surgeons began to perform off-pump coronary artery bypass, done without cardiopulmonary bypass. In these operations, the heart continues beating during surgery, but is stabilized to provide an almost still work area in which to connect a conduit vessel that bypasses a blockage.The conduit vessel that is often used is the Saphenous vein. This vein is harvested using a technique known as endoscopic vessel harvesting (EVH).
  
  Section::::Types of cardiac surgery.:Heart transplant.
  
  In 1945, the Soviet pathologist Nikolai Sinitsyn successfully transplanted a heart from one frog to another frog and from one dog to another dog.
   The Heartware HVAD works similarly to the VentrAssist—albeit much smaller and not requiring an abdominal pocket to be implanted into. The device has obtained CE Mark in Europe, and FDA approval in the U.S. Recently, it was shown that the Heartware HVAD can be implanted through limited access without sternotomy.
  
  In a small number of cases left ventricular assist devices, combined with drug therapy, have enabled the heart to recover sufficiently for the device to be able to be removed ("explanted").
  
  Section::::Studies and outcomes.:HeartMate II LVAD pivotal study.
   Open-heart surgery for dogs requires a six- to eight-person team to carefully monitor the patient before and during the invasive surgery. The entire surgery lasts five hours, during which time the dog is connected to a blood oxygenator and the heart is bypassed. The defective heart valve is removed and the replacement valve, typically from bovine pericardium, is precisely sewn into place. The dog’s heart is then restarted and monitored for at least two hours after the surgery is completed. Due to the expense, this is not a common procedure.
  
  Section::::Prosthetic limbs.
   The most common approach for surgeons to reach the heart is a median sternotomy (vertically cutting the breastbone), but other incisions can be employed, such as a left or right thoracotomy. After the heart is exposed, the patient is put on a cardiopulmonary bypass machine, also known as a heart–lung machine. This machine breathes for the patient and pumps their blood around their body – bypassing the heart – while the surgeon replaces the heart valve. Next, an aortic clamp is placed on the aorta, and the heart is stopped (cardioplegia). Depending on the pathology of the mitral valve and surgeon's preference, various approaches can be used to access the mitral valve. The interatrial groove approach involves incising the left atrium posterior to the interatrial groove. The transatrial oblique approach is utilized when the left atrium is small. In this approach, right atrium is opened and another incision is made at the interatrial septum.
   On 13 February 2011, Copeland and his team at the UC San Diego Center for Transplantation, performed the rare "piggyback" heart operation again, resulting in a man having two beating hearts in his chest. Termed a heterotopic heart transplantation, recipient Smith received a donor heart while still keeping his own diseased heart. The alternative option, which would have required two operations, was to offer a Left ventricular assist device (LVAD) as a bridge-to-transplantation.
   As it turns out, Gigi's brain was deprived of oxygen for too long, and on June 16, 2011, she is declared brain dead. On June 29, 2011, Gigi is taken off life support to transplant her heart into Clint Buchanan. The only way that Rex would allow Clint to have Gigi's heart is if Clint agreed to turn over the entire Buchanan fortune to him, lock, stock and barrel. This way, Rex and Shane could go after Todd and Jack and make them pay for what they did to Gigi.
   Dr. Wilfred G. Bigelow of the University of Toronto found that procedures involving opening the patient's heart could be performed better in a bloodless and motionless environment. Therefore, during such surgery, the heart is temporarily stopped, and the patient is placed on cardiopulmonary bypass, meaning a machine pumps their blood and oxygen. Because the machine cannot function the same way as the heart, surgeons try to minimize the time a patient spends on it.
   Patients who have some remaining heart function but who can no longer live normally may be candidates for ventricular assist devices (VAD), which do not replace the human heart but complement it by taking up much of the function.
  
  The first Left Ventricular Assist Device (LVAD) system was created by Domingo Liotta at Baylor College of Medicine in Houston in 1962.
   Full recovery of donor heart function often takes place over hours or days, during which time considerable damage can occur. Other deaths to patients can occur from preexisting conditions. For example, in pulmonary hypertension the patient's right ventricle has often adapted to the higher pressure over time and, although diseased and hypertrophied, is often capable of maintaining circulation to the lungs. Barnard designed the idea of the heterotopic (or "piggy back" transplant) in which the patient's diseased heart is left in place while the donor heart is added, essentially forming a "double heart". Barnard performed the first such heterotopic heart transplant in 1974.
   Although brain-dead (or 'heart beating') donors are considered dead, the donor's heart continues to pump and maintain circulation. This makes it possible for surgeons to start operating while the organs are still being perfused (supplied blood). During the operation, the aorta will be cannulated, after which the donor's blood will be replaced by an ice-cold storage solution, such as UW (Viaspan), HTK, or Perfadex. Depending on which organs are transplanted, more than one solution may be used simultaneously. Due to the temperature of the solution, and since large amounts of cold NaCl-solution are poured over the organs for a rapid cooling, the heart will stop pumping.
   Suffering from end-stage heart failure, former Vice President Dick Cheney underwent a procedure in July 2010 to have a VAD implanted at INOVA Fairfax Hospital, in Fairfax Virginia. In 2012, he received a heart transplant at age 71 after 20 months on a waiting list.
  
  Section::::See also.
  
  BULLET::::- Artificial heart valve
  
  Section::::References.
  
  Section::::References.:General references.
  
  BULLET::::- George B. Griffenhagen and Calvin H. Hughes. "The History of the Mechanical Heart". Smithsonian Report for 1955, (Pub. 4241): 339–356, 1956.
  
  BULLET::::- "Donor saves Detroit pastor living on artificial heart". Fox News. 18 May 2018
  
  Section::::External links.
   BULLET::::- In the Max Brooks novel "World War Z", a character describes operating on a patient who had dextrocardia with situs inversus, and transplants a heart from someone with the same condition. Unbeknownst to him, the transplant heart is infected with the virus Solanum, thus turning the patient into a zombie.
   In the same year, a 51-year old Iraqi male successfully got an artificial heart implanted at BLK Super Speciality Hospital after his heart was left weak due to gunshots and injuries in a kidnapping and ransom case. Nearly 18 months later, his original heart resumed functioning.
  
  Section::::Specialties.
  
  BULLET::::- Anaesthesia and Pain Management
  
  BULLET::::- Arthroscopy & Sports Medicine
  
  BULLET::::- Bariatric Minimal Access Surgery
  
  BULLET::::- Bone Marrow Transplant
  
  BULLET::::- Cancer/Oncology
  
  BULLET::::- Cardiology
  
  BULLET::::- Cardiothoracic/Cardiovascular Surgeries
  
  BULLET::::- Cosmetic Surgery
  
  BULLET::::- Critical Care
  
  BULLET::::- Chest and Respiratory Diseases
  
  BULLET::::- Dental Care/Surgery
  
  BULLET::::- Dermatology
  
  BULLET::::- Diabetes & Endocrinology
  
  BULLET::::- ENT (Head & Neck)
   The donor heart and lungs are positioned and sewn into place. As the donor organs warm up to body temperature, the lungs begin to inflate. The heart may fibrillate at first – this occurs because the cardiac muscle fibres are not contracting synchronously. Internal paddles can be used to apply a small electric shock to the heart to restore proper rhythm.
  
  Once the donor organs are functioning normally, the heart–lung machine is withdrawn, and the chest is closed.
  
  Section::::Post-operation.
   When the septal defects have been repaired and the atrial incision is closed, the previously removed cannula are replaced and the HLM is restarted. The left ventricle is then vented and the cross clamp removed from the aorta, enabling full-flow to be re-established and rewarming to begin; at this point the patient will receive an additional dose of Regitine to keep blood pressure under control. The previously harvested pericardium is then used to patch the coronary explantation sites, and to extend - and widen, if necessary - the neo-pulmonary root, which allows the pulmonary artery to be anastamosed without residual tension; the pulmonary artery is then transplanted to the neo-pulmonary root.
   Occasionally, alternatives to animal tissue valves are used: aortic homografts and pulmonary autografts. An aortic homograft is an aortic valve from a human donor, retrieved either after their death or from their heart if they are undergoing a heart transplant. A pulmonary autograft, also known as the Ross procedure is where the aortic valve is removed and replaced with the patient's own pulmonary valve. A pulmonary homograft (a pulmonary valve taken from a cadaver) is then used to replace the patient's own pulmonary valve. This procedure was first performed in 1967 and is used primarily in children, as it allows the patient's own pulmonary valve (now in the aortic position) to grow with the child.
   Left-Ventricular Assist Devices (LVADs) as often used as a "bridge" to provide additional time while a patient waits for a transplant. For example, former U.S. vice-president Dick Cheney had a LVAD implanted in 2010 and then twenty months later received a heart transplant in 2012. In year 2012, about 3,000 ventricular assist devices were inserted in the United States, as compared to approximately 2,500 heart transplants. The use of airbags in cars as well as greater use of helmets by bicyclists and skiers has reduced the number of persons with fatal head injuries, which is a common source of donors hearts.
  
presuppositions: Person should die when there is no heart in the body. A person needs a heart to pump blood to stay alive during a transplant.
corrections: Surgeons use machines to pump blood while you do not have a heart.  A person doesn't need a heart to stay alive during a transplant as long as a machine is pumping blood for the body.
raw_presuppositions: Person should die when there is no heart in the body. A person needs a heart to pump blood to stay alive during a transplant.
raw_corrections: Surgeons use machines to pump blood while you do not have a heart.  A person doesn't need a heart to stay alive during a transplant as long as a machine is pumping blood for the body.