Evaluation Process
At California Pacific Medical Center, our heart team evaluates 50 to 100 patients each year for transplantation or end-stage disease management. Evaluations occur at the Pacific campus in San Francisco over a two-day period on an outpatient basis.
During your evaluation, you will undergo interviews and a variety of medical tests designed to give a clearer picture of your overall health. The tests are performed to assess the condition of your heart and determine if transplant is an appropriate treatment option. The evaluation may reveal certain conditions that need to be corrected before the transplant surgery and uncover any underlying problems that would affect transplantation.
Criteria for Heart Evaluation
All patients referred to California Pacific Medical Center's Heart Failure & Transplant Program are considered for evaluation regardless of race, creed, color or sex. All patients with end-stage congestive heart failure and Class I-IV symptoms of congestive heart failure will be evaluated as well as patients with cardiomyopathy, malignant arrhythmias and heart muscle diseases.
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Patient Interview
Prior to your evaluation at California Pacific Medical Center, you will speak with members of our heart team by phone to provide a brief history of your cardiac disease and confirm contact information. Your referring physician will forward pertinent medical records or, if time doesn't allow, you will be asked to bring these records to your evaluation.
When you come to San Francisco for your evaluation, you should bring a family member or close friend who can provide support. Your evaluation will begin with a series of interviews with members of the heart team: the transplant cardiologist, cardiac transplant surgeon, transplant coordinator, social worker, psychiatrist and dietitian.
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Meeting the Heart Team
During your meeting with the heart team, they will review your medical history and provide explanations of invasive and noninvasive procedures for heart failure, including transplantation. Specific functions of your team include:
- Transplant Cardiologist: Manages your heart failure treatment and evaluates you for transplantation. Following transplant, the cardiologist monitors your health and immunosuppressive medication regimen.
- Transplant Coordinator: Reviews outpatient biopsies, necessary clinic visits, lab work, medications and their side effects, and program compliance. Following your evaluation, the transplant coordinator will prepare an evaluation summary.
- Social Worker: Evaluates your social history and discusses social issues related to cardiac transplant.
- Psychiatrist: Performs a full psychiatric assessment.
- Dietician: Reviews pre- and post-transplant dietary recommendations and provides an individualized nutritional assessment.
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Procedures and Tests Performed During Evaluation
During your two-day evaluation, you will undergo a series of medical tests to provide a thorough picture of your overall health. These tests include the following:
Pulmonary Function Studies: These tests, which take about one hour and involve blowing into a plastic tube, are used to detect pulmonary (lung) disease. Specifically, pulmonary function studies detect and measure respiratory function abnormalities, spirometry lung volumes, diffusing capacity, vital capacity and forced vital capacity.
MVO2: Myochardial oxygenation tests (MVO2) are performed to measure the amount of oxygen the heart consumes during exercise. You will walk on a treadmill for approximately one hour while breathing into a plastic tube attached to a machine that measures oxygen consumption.
Right Heart Catheterization: A heart catheterization enables physicians to measure pressures in all four chambers of the heart through the insertion of a thin plastic tube or catheter into a vein in your neck. Patients receive a local anesthetic before undergoing the 30-45 minute catheterization procedure and may experience minimal discomfort from the test. Specifically, the catheterization procedure can:
- measure oxygen concentration, saturation, tension and pressure in the various heart chambers;
- detect shunts (diversions of blood flow);
- provide blood samples for analysis;
- determine cardiac output and pulmonary blood flow.
Electrocardiogram (EKG): By connecting electrical wires with suction cups at 10 points on your chest, arms and legs, doctors can observe the electrical activity of your heart and determine if there is damage or change to your heart muscle. Specifically, an EKG detects myocardial infarction and arterial sclerotic heart disease, cardiac arrhythmias, cardiac enlargement, electrolyte abnormalities, pericarditis and pericardial effusion.
Chest X-Ray: This test shows the position and size of your heart, lungs and blood vessels, as well as increased fluid that may be in or around the lungs but not causing any symptoms. Abnormal shadows, displacement or enlargement shown in the X-ray can be an indicator of heart failure.
Extensive blood work: You will have blood drawn to assess baseline electrolytes, iron levels and a complete blood count (CBC). Your blood will also be tested for hepatitis A, B and C, toxoplasmosis, cytomegalovirus (CMV) and HIV. Creatinine clearance is analyzed to indirectly measure renal function and thyroid and coagulation studies are performed. For men over age 40, a prostate specific antigen (PSA) blood test is completed to detect prostate cancer.
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Selection Criteria
Following the evaluation process, results from a patient's medical tests and physical are compiled along with the medical and psychosocial history. A selection committee comprised of heart team members involved in the patient's evaluation reviews this information and makes recommendations based on the patient's overall health. If treatment options such as surgery or conventional medical therapy are not suitable for the patient based on physical condition, he or she will be placed on the transplant waiting list.
After the selection committee meeting, you and a family member or friend will be asked to return to California Pacific to discuss the heart team's recommendations. This follow-up visit takes place about two weeks after your initial evaluation.
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