Cardiopulmonary transplantation

Abstract

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%.

Heart or lung transplanted patients' retrospective views on information and support while waiting for transplantation

“…When waiting for a cardiopulmonary transplantation, more than 90% of adult patients with end‐stage heart disease have dilated or ischaemic cardiomyopathy, and for patients with end‐stage lung disease, more than 30% have chronic obstructive pulmonary disease followed by cystic fibrosis, α1‐antitrypsin deficiency, pulmonary fibrosis and primary pulmonary hypertension (Parizkova & Wright ). During 2008–2009, 7462 adult heart transplantations and 6244 adult lung transplantations were reported from more than 200 centres worldwide (ISHLT, http://www.ishlt.org; accessed 24 January 2012).…”

“…During 2008–2009, 7462 adult heart transplantations and 6244 adult lung transplantations were reported from more than 200 centres worldwide (ISHLT, http://www.ishlt.org; accessed 24 January 2012). Most centres perform fewer than 30 heart or lung transplants per year, and there is a shortage of donated heart and lungs compared to potential recipients (Parizkova & Wright ). The inevitable fact that someone must die to make a donation possible adds to the patients' stress (Youngner ).…”