cardiac transp

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Transplantation Surgeries

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HistoryHistoryy 1933 Heterotopic - Animal model - Mann

y 1950 Orthotopic Animal model

y 1958 Goldberg and coworkers Success

y 1963 First human LUNG TRANSPLANT

Hardy

y 1967 - 68 Successful human - human hearttransplant Christian Barnard.

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Indications fortransplantationsIndications fortransplantations

Orthotopic heart

Heterotopic heart

y Cardiomyopathy

y CAD

y CHD

y Valvular heart disease

y Cardiac Tumors

y Amyloidosis

y Patients with high

pulmonary vascularresistance.

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Heart - Lung

Single Lung

y CHD

Eissenmengers Syndrome

y

Cystic Fibrosis

y Primary Pulmonary

Hypertension

y Pulmonary fibrosis or other

restrictive disease

y Emphysema

y 1 antitrypsin deficiency

y Pulmonary vascular disease

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Double Lung

Thoracicorganrepeat

transplantation

y Patient with an infectious

lung disease.

y Emphysema

y Primary Pulmonary

Hypertension

y Bronchiolitis Obliterans

y Graft Failure

y Severe Acute Rejection

y Airway Problems

y Transplant CAD

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ContraindicationstotransplantationsContraindicationstotransplantations

y Advanced age ( > 60 years)

y Severe vascular disease

y Irreversible hepatic or renal dysfunction

y Active infection

y Insulin requiring Diabetes mellitus

y Poor medical compliance

y Systemic disease which will significantly limits survival or

rehabilitation.

y Previous lung transplantation

y Resistance to antibiotic used to treat infection.

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Recipientselection forhearttransplant

y NYHA class IV or III heart disease

y Vascular disease

y No evidence of malignancy for > 5 yrs

y No CI to drugsy Non alcoholic, smoker & substance abuse

y Financial requirements

y No active infection

y Motivation to survive

y Left ejection fraction >20%

y Ambulatory with rehabilitation potential.

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Recipientselection forlungtransplant

y No evidence of malignancy for > 5 yrsy Severe obstructive or restrictive lung disease

y No contraindication to drugs

y N

on alcoholic, smoker or substance abusey Ambulatory with rehabilitation potential

y Financial requirements

y No organisms in sputum

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Donor Selection

Heart Donors Lung Donorsy Age < 40 years

y No H/O cardiac disease

y No present infection

y No HIV and Hepatitis B (+)

y No prolonged resuscitative

efforts applied prior to

death.y ABO compatibility

y Age < 35 years

y CXR free of infiltrates

y Clear bronchoscopy

y No significant chest trauma

and pulmonary contusion.

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Heart - Lung Donors

y Age < 40 years

y No major thoracic trauma

y No past H/O pulmonary disease

y

No systemic or pulmonary infectionsy Normal ABG

y Normal ECG

y Normal lung compliance

y Inotropic requirement


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Transportationof Donorheart

y Put in ice cold Hartmanns solution

y Aorta is clamped

y Medicut is inserted into the aorta and

connected to Hartmanns containing 1 ampuleof Cardioplegia Infusion.

y Leads to stopping of heart.

y Transported in Hartmanns solution packed in 3

sterile bags and put into a cool box filled with

ice.

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Surgical Procedures

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Cardiactransplantation

y Heterotopic transplantation (piggyback technique)

y Incision median sternotomy

y Donor heart is connected to native heart

y

Donor Rt & Lt atrium Recipient Rt & Lt atriumy Ascending aorta are anastomosed together

y Pulmonary arteries are connected via Dacron tube graft

y 4 atrias function as 2

y Venous return is shared between two heartsy CO occurs independently

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Advantage

Ability of native heart to assist the donor heart with

CO

Disadvantage

Presence of angina and arrhythmias

Need for long term anticoagulation therapy

Use of prosthetic graft for pulmonary artery anast.

Higher mortality heart Increase in right lobe atelectasis due to compresion

from donors heart

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Orthotopic transplantation

y Incision median sternetomy

y Use of CPBM

y Recipient heart is excised, leaving a sizable cuff

of Lt and Rt atriumy Aorta and pulmonary artery are dissected

y Donor heart is prepared and anastomosed:

y

Left and right atrium to Lt and Rt atrial cuffy Pulmonary arteries and then aorta are

anastomosed

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Lung transplantation

y Double lung transplantation

y Pulmonary veins are detached from the heart with a cuff

of left atrium, pulmonary arteries are transected, and the

lungs are removed.

y Anastomoses of pulmonary artery followed by bronchial.

y Single lung transplantation

y Incision posterolateral thoracotomy

y Anastomosis of atria followed by pulmonary artery and

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Heart lung transplantation

y Incision median sternotomy and ant. Pericaridectomy

y Use of CPBM

y Ascending aorta is clamped

y

Heart and lungs are excised at the aorta just above theaortic valve, the atrioventricular groove of Rt atrium,

across the trachea above the level of carina.

y Prepare the donor heart and lung

y Anastomosis of trachea, aorta, IVC and SVC

y Resuscitation of heart and lung.

y Closure of thoracic cavity.

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Physiotherapy Management

y CARDIAC REHABILITATION

Phase 1

Phase 2

Phase 3

Phase 4

y PULMONARY REHABILITATION

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Thank You

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cardiac transp