Heart biopsies are done as an outpatient procedure under local anesthesia. An intravenous line is placed into a vein in your neck, through which the bioptome is introduced directly into the heart. Under X-ray guidance, five tiny pieces of the heart are removed and sent to the pathology department for microscopic evaluation. The procedure takes about 20 minutes and is performed at the time of your clinic visit. You can go home immediately afterwords. In the year following your transplant, you will have frequent biopsies.
The biopsy "grade" reflects a standardized scoring system based on how many rejection cells are seen in the biopsy specimen. The biopsy grade and your overall heart function will dictate the type of treatment you receive.
At the conclusion of your first year after transplant and every subsequent year, you will undergo a coronary angiogram. This is performed to screen for the development or progression of a secondary form of rejection, which affects not the heart muscle itself (which is why a biopsy is done), but the arteries that supply blood to the new heart. This type of rejection forms slowly over years and is what prevents the transplanted heart from working forever. When this form of rejection becomes diffuse or extensive, the heart muscle weakens and symptoms of congestive heart failure can recur. Although sometimes bypass surgery is feasible, the remaining treatment at this junction is to perform another transplant.
After the first year, the frequency of clinic visits and biopsies will be dictated by your medical condition. Typically in the second year, no more than two to three biopsies are required. Throughout your post transplant course, you will form a strong connection to your cardiologist and coordinator. Most people return to an active lifestyle that includes working and traveling. Although there are some restrictions, most post-transplant problems are avoided by common sense and through the close communication with your transplant team.
We sponsor weekly support group meetings in the hospital that patients and their families can attend. A different educational topic is presented each week, followed by a general support session. Here at Columbia, we are dedicated to returning your life to a sense of normalcy quickly. We understand the demands of the program on each patient but we strive, as a team, to ensure quality care and a long-term friendship for transplant recipients and their families.