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Severe Hypertension After Cardiac Transplantation

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Part of the book series: Difficult Decisions in Surgery: An Evidence-Based Approach ((DDSURGERY))

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Abstract

The development of hypertension after cardiac transplantation is considered one of its most common comorbidities; it occurs early after transplant and can be difficult to manage. The development of hypertensive urgency or emergency perioperatively warrants expeditious assessment and management in an effort to evade the sequelae of uncontrolled acute postoperative hypertension. Such sequelae may include hemorrhage, disruption of vascular or cardiac suture lines, failure of anastomoses, cardiac arrhythmia, hyperperfusion syndrome, cerebral edema or ischemia, bleeding at the surgical site, and end organ damage. Blood pressure should be monitored continuously and short-acting intravenous antihypertensive agents should be administered to target a MAP generally within ±20% of the patient’s baseline value once alternative causes for postoperative hypertension are mitigated. An intravenous calcium channel blocker such as nicardipine or clevidipine or sodium nitroprusside with or without nitroglycerin can safely and effectively lower MAP to the desired range. The use of intravenous fenoldopam is a reasonable alternative in patients with or at risk for renal dysfunction.

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  1. The University of Chicago Medicine, Chicago, IL, USA

    Laura M. Lourenço & Gene Kim

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  1. Laura M. Lourenço
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  2. Gene Kim
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  1. University of Chicago Medicine, Chicago, IL, USA

    Vassyl A. Lonchyna

Appendix (Table 24.3)

Appendix (Table 24.3)

Table 24.3 Pharmacotherapeutic options
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Lourenço, L.M., Kim, G. (2019). Severe Hypertension After Cardiac Transplantation. In: Lonchyna, V. (eds) Difficult Decisions in Cardiothoracic Critical Care Surgery. Difficult Decisions in Surgery: An Evidence-Based Approach. Springer, Cham. https://doi.org/10.1007/978-3-030-04146-5_24

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