Some aspects of clinical & anesthetic management of heart transplantation.

Heart transplantation has become a widely and frequently used therapeutic approach for end stage cardiac disease. However, there is no absolute agreement concerning certain aspects related to the clinical and anesthetic management of the donor and the recipient. The most common indications for heart transplantation are the dilated cardiomyopathy of idiopathic origin and the ischemic cardiomyopathy. There are several contraindications for transplantation. Once a patient is initially accepted as a possible candidate for transplantation, it is important to rule out the presence of fixed pulmonary vascular hypertension, since its presence has been associated with dismal results. The immunosuppression protocols are multiple and diverse. Use of sterile intubation techniques, rapid induction anesthesia and vasopressors as needed are the hallmarks of the anesthetic management of the recipient. Among the most challenging problems in the immediate post-operative period are the low cardiac output and the control of potassium balance. These and other problems will be addressed in the following article.