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Cardiac Transplantation

Cardiac Transplantation. Cardiac Transplantation. Often the treatment of choice for patients with end-stage heart disease who are unlikely to survive the next 6-12 months. Over 50% are patients with cardiomyopathy Inoperable CAD is the 2 nd most common indication for transplantation.

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Cardiac Transplantation

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  1. Cardiac Transplantation

  2. Cardiac Transplantation • Often the treatment of choice for patients with end-stage heart disease who are unlikely to survive the next 6-12 months. • Over 50% are patients with cardiomyopathy • Inoperable CAD is the 2nd most common indication for transplantation

  3. Cardiac Transplantation • Evaluation of Patients: • Who would meet the criteria for cardiac transplantation? • Physical exam • Psychological assessment is valuable also • Hx. of coping ability; family support system; motivation to follow through with rigorous transplantation regimen

  4. Cardiac Transplantation • Placement on Transplant list • If stable: • Home • Waiting • Ongoing medical care • If unstable: hospitalized

  5. Cardiac Transplantation • Donor and recipient matching • Based on body and heart size • ABO type • If bringing in heart from a distance, maximum acceptable ischemic time for transplantation = 4-6 hrs.

  6. Cardiac Transplantation • Recipient prepared for surgery • Cardiopulmonary Bypass is used • Recipient heart removed • Donor heart trimmed and placed • Immunosuppressive tx. usually begins in the OR

  7. Post-Op • Recover • Most of the time, skip recovery room and go straight to ICU • ETT with Ventilator (2-24 hours) • Vasoactive IV Drips and insulin gtt • Temporary chest tubes (~24 hours) • Temporary pacemaker (3-4 days) • Drainage tube in leg (JP) • Families need support during this time because…

  8. Post-Operative Hospitalization • After overnight stay in ICU, Pt. begins cardiac rehabilitation process • Progress Diet and Activity • Cardiac Rehab (Diet teaching) • Sternal Precautions • I.S. Q1hour, cough and deep breath Q2 hours • (Pulmonary Toilet)

  9. Post-Operative Hospitalization • Pain control • ASA, Beta Blockers, Ace Inhibitors, Cholesterol medications • Aggressive blood sugar control • Diuretics to decrease 10-20 lb. weight gain • Discharge in 5-7 days • Requirements: • BM • Weight returned to normal

  10. Discharge Teaching • Report CP, SOB, or S/S of infection to surgeon immediately • Continue Incentive Spirometer, C&DB, and Increasing Activity • Stool Softeners as long as on pain meds • Instruct pt. not to bear down when trying to have BM

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