Anesthesia for cardiac transplantation

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The anesthetic care of the transplant patient requires the services of an experienced cardiac anesthesiologist for patients who have end-stage cardiac disease. Strict attention to detail and close observation and treatment of physiologic trends are required. This paper summarizes the special care required for these patients, any differences in the technique from the regular cardiac surgery patient, and the physiologic and pharmacologic responses of the denervated heart. Also, current statistics of the Stanford Cardiac Transplantation Program are presented.

At Stanford we have transplanted more than 200 hearts since January 1968. Table 1 lists the primary diagnoses of 180 recipients. The two most common diagnoses are coronary artery disease and idiopathic cardiomyopathies. In Figure 1 the survival rates of patients admitted to the Stanford Cardiac Transplantation Program, who had not yet undergone cardiac transplantation are plotted versus the survival rates of patients who had undergone transplantation. As a group, patients who do not undergo cardiac transplantation survive less than 6 months; patients who undergo transplantation currently have a 66% chance of surviving one year and a 50% chance of surviving 5 years.1, 2

Contraindications to cardiac transplantation include patients older than 55 years, those with multiorgan failure at time of transplantation, active infection, insulin-dependent diabetes mellitus, pulmonary vascular resistance of more than 8 Wood units, and positive lymphocyte cross matching (cytotoxic effect of recipient serum against donor cells).

Figure 2 shows the actuarial survival statistics of the Stanford Cardiac Transplantation Program. Improvements in care have significantly increased the survival in the . . .



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