SYMPOSIUM ON CARDIAC TRANSPLANTATION-Part II
Cardiac Transplantation: Surgical Considerations and Early Postoperative Management
CHRISTOPHER G. A. McGREGOR, M.B.,* Division of Thoracic and Cardiovascular Surgery The limited availability of donor hearts is the major constraint to the expanded application of cardiac transplantation. As many as 25 % of potential recipients will die before a donor becomes available. Since 1986, hospitals that receive Medicare and Medicaid funds have been required to ask family members of all brain-dead patients who are potential donors whether they have considered organ donation. The United Network for Organ Sharing is responsible for the national organ procurement and transplantation network as well as the national organ transplantation scientific registry. The increasing occurrence of multiorgan donation is amplifying the demands for intensive-care management of donors. Donor and recipient are matched on the basis of ABO blood group and body size. The donor operation can be performed in any standard operating room. Although the maximal acceptable ischemic time for a donor heart is 4 to 6 hours, briefer preservation times result in better hemodynamic performance after transplantation and a significantly lower 30-day mortality. The technique of choice in most medical centers is orthotopic cardiac transplantation. Postoperatively, most patients remain in the intensive-care unit for 1 or 2 days and in the hospital for 1 to 2 weeks. Standard intensive-care procedures after transplantation, including nursing and cardiovascular management as well as the treatment of failure of the donor heart, are reviewed. A comprehensive educational program for patients and their families should optimize the outcome after heart transplantation. The overall charges for heart transplantation averaged $114,000 in 1987,80% of which were hospital charges. Of 65 companies that account for 72 % of group health insurance business in the United States, 55 pay for heart transplantation. Cardiac transplantation is a proven effective therapy for selected patients with end-stage heart disease. Predictable 1- and 5-year survivals of at least 80% and 60%, respectively, are achievable after transplantation, and individual patients have survived 20 years.
This report focuses on the surgical aspects of cardiac transplantation, including important donor issues, matching of donors and recipients, surgical techniques for the donor and recipient operations, and early postoperative management. Other contributions in this symposium provide detailed discussions of immunosuppression and management of infec*Director of Cardiothoracic Transplantation. Address reprint requests to Dr. C. G. A. McGregor, Division of Thoracic and Cardiovascular Surgery, Mayo Clinic, Rochester, MN 55905. Mayo Clin Proc 67:577-585, 1992
tious diseases; in this article, postoperative nursing, cardiovascular, and intensive-care management will be reviewed. Aspects of rehabilitation, patient education, costs, and results will also be discussed. THE CARDIAC DONOR The limited availability of donor hearts is the major constraint to the expanded application of cardiac transplantation.P In 1990, 2,085 transplantations of the heart were performed in the United States'
Cardiac Transplantation: Surgical Considerations and Early Postoperative Management
CHRISTOPHER G. A. McGREGOR, M.B.,* Division of Thoracic and Cardiovascular Surgery The limited availability of donor hearts is the major constraint to the expanded application of cardiac transplantation. As many as 25 % of potential recipients will die before a donor becomes available. Since 1986, hospitals that receive Medicare and Medicaid funds have been required to ask family members of all brain-dead patients who are potential donors whether they have considered organ donation. The United Network for Organ Sharing is responsible for the national organ procurement and transplantation network as well as the national organ transplantation scientific registry. The increasing occurrence of multiorgan donation is amplifying the demands for intensive-care management of donors. Donor and recipient are matched on the basis of ABO blood group and body size. The donor operation can be performed in any standard operating room. Although the maximal acceptable ischemic time for a donor heart is 4 to 6 hours, briefer preservation times result in better hemodynamic performance after transplantation and a significantly lower 30-day mortality. The technique of choice in most medical centers is orthotopic cardiac transplantation. Postoperatively, most patients remain in the intensive-care unit for 1 or 2 days and in the hospital for 1 to 2 weeks. Standard intensive-care procedures after transplantation, including nursing and cardiovascular management as well as the treatment of failure of the donor heart, are reviewed. A comprehensive educational program for patients and their families should optimize the outcome after heart transplantation. The overall charges for heart transplantation averaged $114,000 in 1987,80% of which were hospital charges. Of 65 companies that account for 72 % of group health insurance business in the United States, 55 pay for heart transplantation. Cardiac transplantation is a proven effective therapy for selected patients with end-stage heart disease. Predictable 1- and 5-year survivals of at least 80% and 60%, respectively, are achievable after transplantation, and individual patients have survived 20 years.
This report focuses on the surgical aspects of cardiac transplantation, including important donor issues, matching of donors and recipients, surgical techniques for the donor and recipient operations, and early postoperative management. Other contributions in this symposium provide detailed discussions of immunosuppression and management of infec*Director of Cardiothoracic Transplantation. Address reprint requests to Dr. C. G. A. McGregor, Division of Thoracic and Cardiovascular Surgery, Mayo Clinic, Rochester, MN 55905. Mayo Clin Proc 67:577-585, 1992
tious diseases; in this article, postoperative nursing, cardiovascular, and intensive-care management will be reviewed. Aspects of rehabilitation, patient education, costs, and results will also be discussed. THE CARDIAC DONOR The limited availability of donor hearts is the major constraint to the expanded application of cardiac transplantation.P In 1990, 2,085 transplantations of the heart were performed in the United States'
