Anaesthesia considerations in heart transplantation: A comprehensive review

Abstract

In over 56 years since the first heart transplant, the science of heart transplantation has evolved from an experimental procedure to an established standard of care for end-stage heart failure. The process involves appropriate patient selection, the listing of recipients, pre-operative optimization, intraoperative management, post-operative care, and follow-up. A robust transplant team, strong government backing, and positive support from the population are essential criteria for the success of any transplant program. Management of heart transplant recipients from the Anaesthesia perspective is challenging due to a myriad of patient risk factors; and the urgent nature of surgery due to the unpredictable nature of donor heart availability. The intraoperative aim is safe induction of anaesthesia, strict asepsis, immunosuppressive therapy, anticipation of major vascular injury, managing pulmonary vascular resistance, ventricular support, optimal ventilatory strategy, and good haemostasis. The postoperative goal is preventing infection, haemodynamic management, gradual weaning of supports, adequate analgesia, monitoring for complications, physiotherapy, and early discharge of the patient from the intensive care unit. There is an increased complexity of heart transplant recipients, due to the increasing use of pre-transplantation mechanical circulatory support devices. The cardiac anaesthesiologist needs to have knowledge of the modern changes in the field of Heart Transplant. The goal of this paper is to provide an overview of the heart transplant origins in India, donor pre-operative workup, intra-operative anaesthesia care, and early post-operative management of heart transplant patients.