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18 Cards in this Set
- Front
- Back
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What immunosuppressive agent that made cardiac transplant an accepted surgical option for End stage heart failurre?
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Cyclosporine
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What is the goal of the preop eval for heart transplant?
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to confirm the Class D heart failure ( HF that has been maximally treated but will still result in death within 1 year)
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What are the four selection guidelines for heart transplant and allocation?
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1. Priority (ESHF Class D or NYHA class IV)
2. Blood type 3. Body size 4. Distance from donor site |
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who is given the highest priority with heart transplant selection?
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Those who are on mechanical assist devices.
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What is the expanded criteria candidate?
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Extends candidates to those who are over the age of 65 , and have diabetes-- extends donors to over age 60.
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What is the time limit from harvest to reimplantation?
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6 hours!
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what area of the body is prepped for orthotropic heart transplant?
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the sternum and both groins
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What is the surgical sequence of heart transplant:
a. Native heart is excised at level of atria b. Sternal incision then sternotomy c. CPB is initiated with hypothermia to 28- 30deg d. superior & inferior vena cava of anastomosed with donor e. systemic rewarming f. aorta then VC cannulation g. Atria (left then right) anastomosed to donor heart h. TEE to ensure deairing i antirejection drugs given |
b. Sternal incision then sternotomy
f. aorta then VC cannulation c. CPB is initiated with hypothermia to 28- 30deg a. Native heart is excised at level of atria g. Atria (left then right) anastomosed to donor heart d. superior & inferior vena cava of anastomosed with donor e. systemic rewarming h. TEE to ensure deairing i antirejection drugs given |
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What is the number one reason for failure to wean from Bypass?
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Right heart Failure, whihc has caused high PA pressures
--give inotropes, (isuprel or dobutamine) |
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What type of medications will the transplanted heart respond to?
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Direct acting drugs only due to the donor heart lacks autonomic control of chronotropy and inotrophy due to denervation
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Describe Isoproterenal?
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-nonselective B agonist
-positive chrontrope and inotrope -pulmonary and systemic vasodilator |
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Describe dobutamine?
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-B agonist with minimal Alpha agonist action
- Pos Chrono- Pos Inotr - Pulm and Systemic vasodilator |
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Describe Epinephrine?
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- Alpha and beta agonist
- Beta rector dominates at lower doses - RV inotrope |
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Describe vasopressin?
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-- V1 receptor on smooth musc. and V2 on distal collecting tubule (inc water reabsorption)
--vasoconstriction (G-protein and phospholipid C) -releases Ca+ from sarcoplasmic reticulum |
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what drug is the mainstay of chrontrophic therapy in heart transplant patients?
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Isoproterenol-- due to it's direct acting chrono and inotr effects.
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What happens to the beta affects of epi and norepi in heart transplanted patients?
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they are exagerated
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What might you see on the ekg of a heart transplanted patient that may have you thinking your patient is in complete heart block?
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two P-waves may be seen, one fromthe native atrium and one from the transplanted one
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Is regional anesthesia an option for pt's with transplanted hearts having hip surgery?
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No the denervated heart does not reflexively comensate for hemodynamic changes induced by regional anesthesia, General anesthesia is preferred.
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