Anesthesia for Cardiac Transplantation

2019 ◽  
pp. 244-257
Author(s):  
Stefan Lombaard ◽  
Heather Reed ◽  
Samantha Arzillo
Keyword(s):  
Heart Failure ◽  
Heart Transplantation ◽  
Heart Transplant ◽  
Cardiac Transplantation ◽  
Treatment Options ◽  
Definitive Therapy ◽  
Patients With Heart Failure ◽  
End Stage Heart Failure ◽  
End Stage ◽  
Induction Agents

Heart transplantation is indicated when other treatment options for patients with heart failure are no longer effective or when a heart transplant would improve survival. There are currently a variety of treatment options for these patients; the options range from medical therapy to full mechanical support. Heart transplantation remains the definitive therapy for end-stage heart failure. This discussion focuses on the management of a patient who presents for a heart transplant as well as some of the challenging clinical issues that may present during this period. Anesthetic induction agents may depress cardiovascular function and result in cardiovascular collapse. Drugs should be chosen that have limited hemodynamic effects.

scholarly journals THE USE OF MELD SCORE (MODEL FOR END-STAGE LIVER DISEASE) AND DERIVATIVES IN CARDIAC TRANSPLANTATION

2018 ◽  
Vol 31 (2) ◽  
Author(s):  
Ana Claudia Oliveira de MORAES ◽  
Olival Cirilo Lucena da FONSECA-NETO
Keyword(s):  
Heart Failure ◽  
Liver Disease ◽  
Heart Transplantation ◽  
Cardiac Transplantation ◽  
Meld Score ◽  
Patients With Heart Failure ◽  
Cirrhotic Patients ◽  
End Stage Heart Failure ◽  
Score Model ◽  
End Stage

ABSTRACT Introduction: Heart transplantation is still the best therapeutic alternative for the treatment of end-stage heart failure. The use of criteria that consider the complications associated with this procedure can guarantee a better evaluation of the recipient and prepare the team for possible unsatisfactory post-transplant results. The use of the MELD score has been expanded to evaluate cirrhotic patients undergoing various procedures, including cardiac transplantation. Objective: To analyze the knowledge on MELD score and its derivatives to the prognosis of patients with end-stage heart failure considered for heart transplantation. Method: Was carried out an integrative review of the publications of the last ten years in Pubmed and Lilacs databases, using the descriptors “heart transplantation”, “liver disease” and “prognosis”. From the total of 111 articles found, six were selected and composed the sample. Results: The MELD-XI score (eXcluding INR) was the most analyzed in the studies due to the exclusion of INR, since many patients with heart failure use anticoagulants, which may alter their value. MELD and derivatives were associated with unsatisfactory results in cardiac transplantation. Conclusion: The MELD score can be considered as a good predictor for heart transplantation; however, there are still few studies that make this correlation.

Abstract 14797: Pediatric Arrhythmogenic Ventricular Cardiomyopathy Often Misclassified in End Stage Heart Failure Patients - A 30 Year Tertiary Care Center Experience

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Swati Choudhry ◽  
Debra L Kearney ◽  
Kyle D Hope ◽  
Hari P Tunuguntla ◽  
Joseph Spinner ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ventricular Arrhythmia ◽  
Heart Transplantation ◽  
Heart Transplant ◽  
Restrictive Cardiomyopathy ◽  
Young Population ◽  
Ventricular Cardiomyopathy ◽  
Heart Failure Patients ◽  
End Stage Heart Failure ◽  
End Stage

Introduction and Background: Arrhythmogenic ventricular cardiomyopathy (AVC) is a hereditable disorder characterized by fibro-fatty infiltration of the right ventricular myocardial wall. The purpose of this study was to describe the clinicopathologic phenotype of AVC in pediatric end-stage heart failure patients who underwent heart transplantation (HTx). Hypothesis: We hypothesized that AVC is misclassified in the young population who require heart transplant. Methods: We investigated 371 consecutive cases of primary pediatric (≤21 years) heart transplantation performed at Texas Children’s hospital between 1989 and 2018. Heart re-transplants were excluded from the study. Explanted hearts and tissue blocks were examined by a cardiac pathologist after HTx. Histological Diagnosis of AVC was based on the presence of major and minor diagnostic criteria according to the 2010 Revised Task Force Criteria. Results: Over half of the patients who underwent HTx had cardiomyopathy (212/371=57%) as the underlying primary diagnosis. After comprehensive histological evaluation of explanted hearts, 8 cases (8/212=3.8%) were diagnosed with AVC. Predominantly right ventricular disease was seen in 2/8 (25%), and biventricular involvement in 6/8 (75%) patients on pathological examination. Six out of 8 patients (6/8=75%) were misclassified, 4 as dilated cardiomyopathy, 1 as viral myocarditis, and 1 as restrictive cardiomyopathy. The median age at heart transplant (AVC cohort) was 11 years. Four of 8 (50%) were males. Six of 8 (75%) had a significant ventricular arrhythmia burden manifesting as non-sustained ventricular tachycardia requiring antiarrhythmic therapy. Genetic testing was undertaken in 3 of 8 (37.5%); all three were found to have pathogenic mutations in the PKP2 gene. Conclusion: Arrhythmogenic ventricular cardiomyopathy is often misclassified in the young population who require heart transplant. Pediatric dilated and restrictive cardiomyopathy phenotypes with end-stage heart failure waitlisted for a heart transplant (HT) who have a significant ventricular arrhythmia burden should be investigated for AVC.

scholarly journals Pre- and Postoperative Evaluation of Patients with End-Stage Heart Failure Undergoing Cardiac Transplant – a Descriptive Study

2020 ◽  
Vol 5 (3) ◽  
pp. 91-95
Author(s):  
Costel Dumitru ◽  
Dana Ghiga ◽  
Septimiu Voidazan ◽  
Alexandra Grosan ◽  
Dan Simpalean ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Postoperative Complications ◽  
Heart Transplantation ◽  
Heart Transplant ◽  
Clinical Laboratory ◽  
Left Ventricular Ejection ◽  
Postoperative Evaluation ◽  
End Stage Heart Failure ◽  
End Stage

AbstractBackground: Heart transplantation is still the treatment of choice in patients with end-stage heart failure, refractory to medical treatment, in NYHA class III and IV, with dilated cardiomyopathy of various etiologies, including post-myocardial infarction.Objective: The aim of the study was to provide a descriptive analysis of the clinical, laboratory, and imaging parameters of patients undergoing heart transplantation during the pre- and postoperative period, as well as postoperative complications (including infections) and death rates.Material and methods: The variables collected from 53 patients who underwent a heart transplant were: age at heart transplant, gender, diagnosis at hospitalization, comorbidities, pre- and postoperative virology, pre- and postoperative laboratory analyses, pre- and postoperative echocardiography, post-transplant infections, complications, and treatment before and after the surgery.Results: Mean age at the time of transplant was 40.72 ± 14.07 years, and the majority (84.91%) of patients were males. The mean age of the donors was 31.92 ± 10.59 years. A proportion of 60.40% of patients were included in functional class NYHA IV, and 98.1% presented dilative cardiomyopathy of which 49.06% was due to previous myocardial infarction. No significant differences were observed between preand postoperative viral and bacterial serology. Left ventricular ejection fraction was significantly higher in the transplanted heart, and cardiac chamber diameters were significantly smaller after the transplant. Postoperative complications included 7 confirmed infections and 16 deaths, of which 5 had occurred during the surgical procedure.Conclusions: The present study brings important information in regard to the pre- and postoperative evaluation of patients with end-stage heart failure undergoing cardiac transplantation, from a clinical, laboratory, and imaging point of view, as well as in regard to postoperative complications and death.

170 Heart Transplantation in 11 Patients with End Stage Heart Failure Caused by Muscular Dystrophy

2012 ◽  
Vol 31 (4) ◽  
pp. S66
Author(s):  
U. Fuchs ◽  
U. Schulz ◽  
B. Schulze ◽  
A. Zittermann ◽  
K. Hakim-Meibodi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Muscular Dystrophy ◽  
Heart Transplantation ◽  
End Stage Heart Failure ◽  
End Stage

Deloading of the Left Ventricle by Ventricular Assist Device Normalizes Increased Expression of Endothelin ET A Receptors But Not Endothelin-Converting Enzyme-1 in Patients With End-Stage Heart Failure

Circulation ◽  
2000 ◽  
Vol 102 (suppl_3) ◽  
Author(s):  
Henning Morawietz ◽  
Marten Szibor ◽  
Winfried Goettsch ◽  
Babett Bartling ◽  
Matthias Barton ◽  
...  
Keyword(s):  
Heart Failure ◽  
Heart Transplantation ◽  
Ace Inhibitor ◽  
Ventricular Myocardium ◽  
Left Ventricular ◽  
Left Ventricular Myocardium ◽  
Converting Enzyme ◽  
Ventricular Assist ◽  
End Stage Heart Failure ◽  
End Stage

Background —Ventricular assist devices (VAD) are implanted in patients with end-stage heart failure for bridging the time until heart transplantation, resulting in hemodynamic unloading of the failing heart, improved cardiac contractile and mitochondrial function, and reversal of cardiac hypertrophy. It is unknown whether VAD unloading may affect the cardiac endothelin (ET) system, which has been proposed as one of the putative pathomechanisms of heart failure. Methods and Results —With the use of standard-calibrated, competitive reverse-transcription–polymerase chain reaction mRNA expression of components of the ET system was analyzed in left ventricular myocardium from nonfailing donor hearts, from failing hearts without and with ACE inhibitor therapy, and from patients with end-stage heart failure at the time of VAD implantation and 103±15 days after VAD implantation during removal with subsequent heart transplantation. ET receptor A (ET A ) was markedly upregulated in failing human myocardium. This increased ET A expression was not affected by ACE inhibitor treatment but was normalized by VAD unloading. ET A expression before or after VAD implantation did not correlate with duration of VAD implantation or suppression of Pro-ANP mRNA. ET B mRNA expression was unaffected by heart failure or VAD. In contrast, increased ET-converting enzyme-1 mRNA and ET-1 peptide levels in failing myocardium were partially normalized by ACE inhibition but not by VAD unloading. Conclusions —We conclude that VAD implantation normalizes ET A expression in failing human left ventricular myocardium, probably as the result of the beneficial effects of VAD unloading.

scholarly journals Home Inotrope Program for Patients with End-Stage Heart Failure Awaiting Heart Transplant

2011 ◽  
Vol 64 (4) ◽  
Author(s):  
Doson Chua ◽  
Arvinder Buttar ◽  
Anemarie Kaan ◽  
Holly Andrews ◽  
Jennifer Kealy ◽  
...  
Keyword(s):  
Heart Failure ◽  
Heart Transplant ◽  
End Stage Heart Failure ◽  
End Stage
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