Skip to main content

Anesthesia for Heart and Lung Transplantation

  • Chapter
  • First Online:
Anesthesiology

Abstract

The evolution of surgical technique and immunosuppression medications during the last half-century resulted in heart and lung transplantation becoming increasingly more common. While these life-saving procedures offer improved survival and quality of life, there are many challenges that need to be mitigated in order to realize these potential benefits. Advanced stage of primary disease, co-morbid conditions, and deconditioning are several factors that may place the recipient at risk of primary graft dysfunction, perioperative complications, and prolonged hospital course. In this chapter, we will review the underlying principles of anesthetic management that can contribute to successful outcomes for these complex operations. Tables 4.4 and 4.5 provide a summary of the considerations during heart and lung transplantation.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 139.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 179.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 249.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. 2016 Annual Report of the U.S. Organ Procurement and Transplantation Network and the scientific registry of transplant recipients. Rockville, MD: Department of Health and Human Services, Health Resources and Services Administration, Healthcare Systems Bureau, Division of Transplantation.

    Google Scholar 

  2. Scientific Registry of Transplant Recipients. Heart. https://www.srtr.org/document/pdf?fileName=\012017_release\pdfPSR\GAEMTX1HR201611PNEW.pdf.

  3. Scientific Registry of Transplant Recipients. Lung. https://www.srtr.org/document/pdf?fileName=\012017_release\pdfPSR\GAEMTX1LU201611PNEW.pdf.

  4. Beer A, Reed RM, Bolukbas S, Budev M, Chaux G, Zamora MR, et al. Mechanical ventilation after lung transplantation. An international survey of practices and preferences. Ann Am Thorac Soc. 2014;11(4):546–53.

    Article  PubMed  Google Scholar 

  5. Thakuria L, Davey R, Romano R, Carby MR, Kaul S, Griffiths MJ, et al. Mechanical ventilation after lung transplantation. J Crit Care. 2016;31(1):110–8.

    Article  PubMed  Google Scholar 

  6. Costanzo MR, Taylor D, Hunt S, et al. The International Society of Heart and Lung Transplantation guideline for the care of heart transplant recipients. J Heart Lung Transplant. 2010;29:914–56.

    Article  PubMed  Google Scholar 

  7. Lannon JD, Ball A, RBC YN, Clark S, Mascaro J, et al. The effect of cold and warm ischemia time on survival after lung transplantation in a large national cohort. J Heart Lung Transplant. 2014;32(4S):S94.

    Article  Google Scholar 

  8. Wagner FM. Donor heart preservation and perfusion. Appl Cardiopulm Pathophysiol. 2011;15:198–206.

    Google Scholar 

  9. Warnecke G, Moradiellos J, Tudorache I, Kuhn C, Avsar M, Wiegmann B, et al. Normothermic perfusion of donor lungs for preservation and assessment with the organ care system lung before bilateral transplantation: a pilot study of 12 patients. Lancet. 2012;380(9856):1851–8.

    Article  PubMed  Google Scholar 

  10. Saez DG, Zych B, Sabashnikov A, Bowles CT, Robertis FD, Prashant NM, et al. Evaluation of the organ care system in heart transplantation with an adverse donor/recipient profile. Ann Thorac Surg. 2014;98(6):2099–106.

    Article  Google Scholar 

  11. Boucek MM, Mashburn C, Dunn SM, Frizell R, Edwards L, Pietra B, et al. Pediatric heart transplantation after declaration of cardiocirculatory death. N Engl J Med. 2008;359(7):709–14.

    Article  CAS  PubMed  Google Scholar 

  12. Dhital KK, Iyer A, Connellan M, Chew HC, Gao L, Doyle A, et al. Adult heart transplantation with distant procurement and ex-vivo preservation of donor hearts after circulatory death: a case series. Lancet. 2015;385(9987):2585–91.

    Article  PubMed  Google Scholar 

  13. Diamond JM, Lee JC, Kawut SM, Shah RJ, Localio AR, Bellamy SL, et al. Clinical risk factors for primary graft dysfunction after lung transplantation. Am J Respir Crit Care Med. 2013;187(5):527–34.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Kobashigawa J, Zuckermann A, Macdonald P, Leprince P, Esmailian F, Luu M, et al. Report from a consensus conference on primary graft dysfunction after cardiac transplantation. J Heart Lung Transplant. 2014;33(4):327–40.

    Article  PubMed  Google Scholar 

  15. Hayanga JW, D’Cunha J. The surgical technique of bilateral sequential lung transplantation. J Thorac Dis. 2014;6(8):1063–9.

    PubMed  PubMed Central  Google Scholar 

  16. Slinger P. Anesthetic management for lung transplantation. Tx Med. 2012;24:24–32.

    Google Scholar 

  17. Wadia Y, Cooper JR, Bracey AW, et al. Intraoperative anticoagulation management during cardiac transplantation. Tex Heart Inst J. 2008;35:62–5.

    PubMed  PubMed Central  Google Scholar 

  18. Barnes L, Reed RM, Parekh KR, Bhama JK, Pena T, Rajagopal S, et al. Mechanical ventilation for the lung transplant recipient. Curr Pulmonol Rep. 2015;4(2):88–96.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Ferrari RS, Andrade CF. Oxidative stress and lung ischemia-reperfusion injury. Oxidative Med Cell Longev. 2015;2015:590987.

    Article  CAS  Google Scholar 

  20. Fischer S, Glas KE. A review of cardiac transplantation. Anesthesiol Clin. 2013;31(2):383–403.

    Article  PubMed  Google Scholar 

  21. Christie JD, Carby M, Bag R, Corris P, Hertz M, Weill D, et al. Report of the ISHLT working group on primary lung graft dysfunction part II: definition. A consensus statement of the International Society for Heart and Lung Transplantation. J Heart Lung Transplant. 2005;24(10):1454–9.

    Article  PubMed  Google Scholar 

  22. Meade MO, Granton JT, Matte-Martyn A, McRae K, Weaver B, Cripps P, et al. A randomized trial of inhaled nitric oxide to prevent ischemia-reperfusion injury after lung transplantation. Am J Respir Crit Care Med. 2003;167(11):1483–9.

    Article  PubMed  Google Scholar 

  23. Tavar AN, Tsakok T. Does prophylactic inhaled nitric oxide reduce morbidity and mortality after lung transplantation? Interact Cardiovasc Thorac Surg. 2011;13(5):516–20.

    Article  Google Scholar 

  24. Pasero D, Martin EL, Davi A, Mascia L, Rinaldi M, Ranieri VM. The effects of inhaled nitric oxide after lung transplanttation. Minerva Anestesiol. 2010;76(5):353–61.

    PubMed  CAS  Google Scholar 

  25. Diamond JM, Ahya VN. Mechanical ventilation after lung transplantation. It’s time for a trial. Ann Am Thorac Soc. 2014;11(4):598–9.

    Article  PubMed  Google Scholar 

  26. Chew HC, Kumarasinghe G, et al. Primary graft dysfunction after heart transplantation. Curr Transplant Rep. 2014;1:257–65. https://doi.org/10.1007/s40472-014-0033-6.

    Article  Google Scholar 

  27. Arafa OE, Geiran OR, Andersen K, Fosse E, Simonsen S, Svennevig JL. Intraaortic balloon pumping for predominantly right ventricular failure after heart transplantation. Ann Thorac Surg. 2000;70(5):1587–93.

    Article  PubMed  CAS  Google Scholar 

  28. Taghavi S, Zuckermann A, Ankersmit J, Wieselthaler G, Rajek A, Laufer G, et al. Extracorporeal membrane oxygenation is superior to right ventricular assist device for acute right ventricular failure after heart transplantation. Ann Thorac Surg. 2004;78(5):1644–9.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Igor O. Zhukov M.D. .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Farmer, B.E., Zhukov, I.O. (2018). Anesthesia for Heart and Lung Transplantation. In: Goudra, B., et al. Anesthesiology. Springer, Cham. https://doi.org/10.1007/978-3-319-74766-8_4

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-74766-8_4

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-74765-1

  • Online ISBN: 978-3-319-74766-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics