Anesthesia in Cardiac Transplantation

This chapter considers the anesthesia perspective on orthotopic heart transplantation (OHT). The overall goal for anesthetic management of advanced heart failure focuses on improving myocardial contraction while decreasing cardiac work and preventing further injury. A growing number of patients presenting for OHT have a mechanical circulatory assist device. These devices vary greatly in design and function, particularly when characterized into nondurable (short-term devices) compared to durable devices. It is critical for the anesthesiologist to understand the different mechanical circulatory devices and parameters to assure hemodynamic stability throughout the perioperative period. Antibiotic prophylaxis is the standard of care for almost all surgical procedures. Anesthesiologists must make note of certain agents that have potential intraoperative implications. Some examples include oral hypoglycemics that can alter glycemic control perioperatively or antihypertensives that can promote vasoplegia following cardiopulmonary bypass. Fluid management during OHT is goal directed and can be complicated and dependent on the individual patient.