Sage Journals: Discover world-class research

Abstract

The early postoperative care of a heart transplant recipient remains challenging, even in experienced centers with a long tradition of excellence. Approximately 10% to 20% of heart transplant recipients experience potentially life-threatening right ventricular dysfunction intraoperatively and early postoperatively due to an elevated pulmonary vascular resistance. In addition, heart transplant recipients experience a high risk of perioperative hemorrhage, as well as opportunistic infection and rejection. The authors describe a case of severe right ventricular dysfunction in a 46-year-old male several hours after heart transplantation for a dilated cardiomyopathy. This patient was salvaged by judicious multimodality therapy including the use of adrenergic agents, phosphodiesterase inhibitors, inhaled nitric oxide, and extracorporeal membrane oxygenation. The risk factors for the development of early graft failure after heart transplantation are reviewed, along with the principles of appropriate management of this complication.

Keywords

cardiac heart transplant postoperative care

Get full access to this article

View all access options for this article.

References

Taylor DO , Edwards LB , Aurora P. , et al. Registry of the International Society for Heart and Lung Transplantation: twenty-fifth official adult heart transplant report-2008. J Heart Lung Transplant. 2008;27:943-956.

Butler J. , Stankewicz MA , Wu J. , et al. Pre-transplant reversible pulmonary hypertension predicts higher risk for mortality after cardiac transplantation. J Heart Lung Transplant. 2005;24:170-177.

Taylor DO , Edwards LB , Mohacsi PJ , et al. Registry of the International Society for Heart and Lung Transplantation: twentieth official adult heart transplant report-2003. J Heart Lung Transplant. 2003;22:616-624.

Stobierska-Dzierzek B. , Awad H. , Michler RE The evolving management of acute right-sided heart failure in cardiac transplant recipients. J Am Coll Cardiol. 2001;38:923-931.

Rajek A. , Pernerstorfer T. , Kastner J. , et al. Inhaled nitric oxide reduces pulmonary vascular resistance more than prostaglandin E1 during heart transplantation. Anesth Analg. 2000;90:523-530.

Ardehali A. , Hughes K. , Sadeghi A. , et al. Inhaled nitric oxide for pulmonary hypertension after heart transplantation. Transplantation. 2001;72:638-641.

De Santo LS , Mastroianni C. , Romano G. , et al. Role of sildenafil in acute posttransplant right ventricular dysfunction: successful experience in 13 consecutive patients. Transplant Proc. 2008;40:2015-2018.

Yerebakan C. , Buz S. , Huebler M. , Weng Y. , Lehmkuhl H. , Hetzer R. Right ventricular failure following heart transplantation-recovery after extended mechanical support. J Card Surg. 2008;23:578-580.

Wang SS Treatment and prophylaxis of cardiac allograft vasculopathy. Transplant Proc. 2008;40:2609-2610.

10.

Schmauss D. , Weis M. Cardiac allograft vasculopathy: recent developments . Circulation. 2008;117:2131-2141.

11.

Raichlin E. , Bae JH , Khalpey Z. , et al. Conversion to sirolimus as primary immunosuppression attenuates the progression of allograft vasculopathy after cardiac transplantation. Circulation. 2007 ;116:2726-2733.

Immediate Postoperative Care of the Heart Transplant Recipient: Perils and Triumphs

Abstract

Keywords

Get full access to this article

References