Cardiopulmonary transplantation: anaesthetic implications

Durkin, Chris; Buckland, Mark

doi:10.1016/j.mpaic.2015.04.010

Cited by 4 publications

(2 citation statements)

References 8 publications

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“…The implanted graft usually presents some level of RVD demanding a normal-high HR (Heart Rate) and high LV (Left Ventricle) filling pressures to maintain an adequate CO [ 46 ]. Concomitant to sinus rhythm, it is desirable to maintain HR of 100–120 [ 1 ] through optimization of inotropes, chemical/electrical cardioversion, and/or temporary epicardial pacing.…”

Section: Resultsmentioning

confidence: 99%

Anesthetic protocol for right ventricular dysfunction management in heart transplantation: systematic review, development and validation

et al. 2021

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Background Right Ventricular Dysfunction (RVD) is the most frequent intraoperative hemodynamic complication in Heart Transplantation (HTx). RVD occurs in 0.04–1.0% of cardiac surgeries with cardiotomy and in 20–50% of HTx, with mortality up to 75%. No consensus has been established for how anesthesiologists should manage RVD, with management methods many times remaining unvalidated. Methods We conducted a systematic review, following PRISMA guidelines, to create an anesthetic protocol to manage RVD in HTx, using databases that include PubMed and Embase, until September 2018 based on inclusion and exclusion criteria. The articles screening for the systematic review were done two independent reviewers, in case of discrepancy, we consulted a third independent reviewer. Based on the systematic review, the anesthetic protocol was developed. The instrument selected to perform the validation of the protocol was AGREE II, for this purpose expert anesthetists were recruited to do this process. The minimum arbitration score for domains validation cutoff of AGREE II is arbitered to 70%. This study was registered at PROSPERO (115600). Results In the systematic review, 152 articles were included. We present the protocol in a flowchart with six steps based on goal-directed therapy, invasive monitoring, and transesophageal echocardiogram. Six experts judged the protocol and validated it. Conclusion The protocol has been validated by experts and new studies are needed to assess its applicability and potential benefits on major endpoints.

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Section: Resultsmentioning

confidence: 99%

Anesthetic protocol for right ventricular dysfunction management in heart transplantation: systematic review, development and validation

et al. 2021

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“…Temporary left ventricular assist devices (LVAD) and the intra-aortic balloon pumps (IABP) were used in the past for poor postoperative cardiopulmonary functions. Recently, extracorporeal membrane oxygenation (ECMO) has been widely used for cardiopulmonary function support (7). For the three recent cases, the active and advanced use of ECMO (V-V in one case and V-A in two cases) achieved favorable results for the support of the donor cardiopulmonary functions.…”

Section: After Chest Closurementioning

confidence: 99%

Anesthetic management of heart and lung transplantation: analysis of 14 cases in a single center

Fang¹,

Zhuang²,

Huang³

et al. 2022

J Thorac Dis

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Background: Aggressive management of heart and lung transplant (HLTx) requires a team of specialists with dedicated expert to improve long-term outcomes. This study aimed to summarize practical experiences of anesthetic management in HLTx operations.Methods: This study retrospectively analyzed the anesthesia-related clinical records of 14 cases of HLTx performed from September 2015 to October 2019. Preoperative diagnoses included congenital heart disease with pulmonary arterial hypertension, idiopathic pulmonary arterial hypertension with right heart failure, end-stage cor pulmonale, dilated cardiomyopathy, end-stage heart failure with pulmonary arterial hypertension, congenital heart disease, and lung transplant failure. All recipients received intravenousinhalation general anesthesia with single-lumen endotracheal intubation, Swan-Ganz catheterization, and transesophageal echocardiography (TEE).Results: All 14 cases of HLTx were completed successfully and the patients were transferred to the intensive care units (ICUs). The postoperative data of the 14 patients were collected from 1 month to 4 years: seven cases survived the first year, four cases died in the short term (within 30 days), and one case died within 24 h. As at the end of November 2019, eight cases were reported dead (the longest survival was 2 years 1 month and 22 days). Four cases used extracorporeal membrane oxygenation (ECMO) for cardiopulmonary support. Conclusions:The success of the HLTx was attributed to the joint efforts of the entire transplantation team. The anesthesiology team was required for experiences in anesthesia for HLTx. The key to anesthesia management was the in-depth participation in preoperative discussions and assessments. Preventing the exacerbation of right heart failure and pulmonary arterial hypertension is critical during the induction of anesthesia. Regulation and support are crucial from the withdrawal of cardiopulmonary bypass (CPB) to within 1 h of the circulation and respiratory functions undertaken independently by the donor heart and lungs.

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