SummaryPatients suffering from conditions requiring specialist intervention cannot obtain treatment when facilities do not exist locally. Specialist visiting teams in a number of surgical disciplines have attempted to address these issues in collaboration with local clinicians. These interventions require careful planning and communication to achieve optimum results. Several teams have been successful in building long-term relationships that have lead to important clinical developments in the local country.

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More than 5260 cardiopulmonary transplants were carried out worldwide between January 2006 and June 2007 across 204 centres. Heart transplantation is a proven surgical option for selected patients who have advanced heart failure refractory to surgical or medical management. Lung transplantation is the definitive treatment for end-stage lung disease for patients who have failed medical therapy. More than 90% of adult patients presenting for heart transplantation have dilated cardiomyopathy or ischaemic cardiomyopathy. Anaesthetic principles for heart transplantation include full monitoring with transoesophageal echocardiography, cardiostable anaesthesia and cardiac support, and assessment and treatment of pulmonary vascular hypertension. Median survival after cardiac transplantation is 10 years. Lung transplantation includes single-lung, double-lung, bilateral sequential single-lung, heartelung and lobar transplantation. The most common indication is chronic obstructive pulmonary disease, which represents more than one-third of all transplant recipients. Donor criteria are becoming more liberal. Most lung transplants involve cardiopulmonary bypass. Pre-bypass air trapping can compromise cardiac function. Postoperative ventilation management should be guided by pH, not P a CO 2 . Thoracic epidural provides optimal analgesia without respiratory depression. Three year survival after lung transplantation is approximately 60% and 5 year survival is approximately 50%.

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