Anesthesia for Heart and Lung Transplantation
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.
KeywordsHeart transplantation Lung transplantation Transplant anesthesia Primary graft dysfunction Ischemia-reperfusion injury Right ventricular failure
- 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.
- 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.CrossRefPubMedGoogle Scholar
- 16.Slinger P. Anesthetic management for lung transplantation. Tx Med. 2012;24:24–32.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.CrossRefPubMedGoogle Scholar