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DPT 528 > Heart and Lung Transplantation > Flashcards

Heart and Lung Transplantation Flashcards

1
Q

what is the 1 year survival rate of heart transplants?

A

86.2%

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2
Q

what is the 1 year survival rate of lung transplants?

A

83.6%

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3
Q

what is the 5 year survival rate of lung transplants?

A

53.4%

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4
Q

what is the 10 year survival rate of lung transplants?

A

28.4%

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5
Q

pts with a lung transplant usually do well for ____ years b4 complications/signs of failure

A

3-4

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6
Q

what is the primary indication for a heart/lung transplant?

A

progressive, terminal cardiopulmonary disease w/limited life expectancy

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7
Q

a majority of heart transplants are due to what diseases?

A

coronary artery disease

myocardial damage

cardiomyopathy

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8
Q

a majority of lung transplants are due to what diseases?

A

emphysema

idiopathic pulmonary fibrosis

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9
Q

t/f: failure of a transplanted organ is an indication for repeat transplant

A

true

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10
Q

referral for transplantation are indicated for patients…

A

who can survive on ionotropic meds (inc heart contractility) and mechanical support until transplant

end stage

frequent hospital readmissions for HF

worsening renal fxn

worsening R HF and rising pulmonary artery pressure from LV failure

frequent ventricular arrhythmias

anemia, weight loss, hyponatremia, liver dysfxn atrributable to HF

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11
Q

an urgent referral for transplant is indicated in pts with…

A

refractory cardiogenic shock w/max dose ionotropic treatment

refractory cardiogenic shock w/percutaneous mechanical circulatory support

refractory pulmonary edema not responsive to diuretics and requiring ventilation and positive pulmonary pressure

refractory ventricular arrhythmia not responding to medical therapy or electrophysiological procedures

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12
Q

what are contraindications for transplants?

A

active infection

chronic liver disease (cirrhosis)

advanced kidney disease (glomerular filtration rate <30 mL/min/1.73 m^2

recent stroke

symptomatic untreated PVD

uncontrolled DM w/end organ damage

active malignancy

severe lung disease (FEV1/FVC<50% predicted)

recent PE requiring anticoagulation (w/in last 3-6 months)

severe pulmonary HTN (systolic pressure >60mmHg)

lack of social support

disabling psychiatric illness

active smoking not willing to quit

non-compliance

morbidly obesity

multisystem disease

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13
Q

t/f: the age for being an organ donor is now over 65

A

true

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14
Q

most organ recipients are under ___ yo

A

59

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15
Q

what factors affect ranking on the transplant list?

A

tissue match

blood type

length of time of the list

immune status

distance bw potential recipient and donor

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16
Q

what test is often done to establish a baseline in transplant referrals?

A

6MWT

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17
Q

what is a left ventricular assist device (LVAD)?

A

bridge to transplant of heart many times

can be internal or external

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18
Q

what are the 4 surgical techniques for heart transplant?

A

1) heterotopic heart transplantation (HHT)
2) total transplantation
3) orthotopic heart transplant-bicaval
4) orthotopic heart transplant-biatrial

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19
Q

what is the heterotopic heart transplant technique?

A

rarely used

donor heart connected to native heart via R and L atria without removing the native heart

4 atria act as 2

pulmonary arteries are connected via Dacron tube graft

donor aorta anatomized to recipient aorta and donor pulmonary artery anastomosed to recipient pulmonary artery

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20
Q

what is the total transplantation heart transplant technique?

A

not frequently used
complete excision of recipient atrai w/complete AV transplantation, separate bicaval and pulmonary venous anastomoses

requires significant amount of time to complete (6 anastomoses)

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21
Q

what is the orthotopic heart transplant-bicaval technique?

A

bicaval anastomoses

donor and recipient hearts connected by sewing separate caval anastomoses

improved atrial fxn and lower rate of arrythmias

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22
Q

what is the distinguishing factor of orthotopic heart transplant-bicaval?

A

involved connecting the sup and inf vena cava of both the donor and recipient

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23
Q

what is the orthotopic heart transplant-biatrial technique?

A

donor and recipient atrial cuffs are sewn together

leaves the recipient SA node in tact

donor SA node operates independently of the recipient’s

2 separate P waves

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24
Q

in what heart transplant technique is the recipient’s SA node sensitive to sympathetic stimulation and will respond to increases in activation?

A

orthotopic heart transplant-biatrial

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25
what are the complications of heart transplantation?
primary graft dysfxn rejection infection delayed complications cardiac allograft vasculopathy malignancy immunosuppressant related side effects
26
what is primary graft dysfxn?
failure of the graft fxn within the 1st 24 hours
27
what is rejection?
interaction bw recipient immune system and donor heart mild rejection w/o donor heart dysfxn severe rejection w/hemodynamic compromise
28
why is infection a complication of heart transplantation?
bc the use of immunosuppressants increases the risk for infection
29
when is the risk of death from infection post heart transplant the greatest?
1 year post-transplant
30
t/f: live vaccines are contraindicated for heart transplant patients
true
31
what is cardiac allograft vasculopathy?
the process that leads to narrowing/occlusion of coronary arteries of donor heart significant cause of death in late post heart transplant
32
t/f: the more time that has passed post-heart transplant the greater the incidence of cardiac allograft vasculopathy
true
33
new onset of malignancies occurs in about __% of transplant pts after 1-5 years
10
34
what are the factors for candidacy for a lung transplant?
end stage lung disease w/all other treatments used w/no improvements pts with alpha-1 antitrypsin deficiency pts w/ COPD pts w/CF pts w/idiopathic pulmonary fibrosis pts w/pulmonary arterial HTN pts w/sarcodoisis
35
what are the contraindications for lung transplant?
concurrent chronic illness (renal, heart, liver) current infection current/recent cancer current use of alcohol, tobacco, or illegal drugs age psychiatric conditions hx of non-compliance
36
what are the 4 surgical techniques for lung transplantation?
1) lobe 2) single lung 3) double lung 4) heart-lung
37
what is a lobe surgical technique for lung transplant?
part of the donor lung replaces the diseases recipient lung portion(s)
38
what is a single-lung surgical technique for lung transplant?
posterolateral thoracotomy transplanting a single healthy lung
39
what pt population often has a double lung transplant?
pts with CF due to bacterial colonization in both lungs
40
how are donor lungs harvested?
pulmonary veins are detached from the heart w/cuff of the L atrium pulmonary arteries are transected the lungs are removed en bloc (all together) and then divided into R and L lungs
41
what is the preferred procedure for lung transplantation?
use of the mainstem bronchial anastomoses BL anterior thoracotomy or BL transsternal thoracotomy (clamshell incision)
42
t/f: the least fxnal lung is removed and transplanted first
true
43
there is improved post-op management and fewer complications due to the use of what?
hemodynamic monitoring devices
44
what are the complications associated with lung transplants?
pt can't feel the urge to cough when the lungs are congested changes in voice HR response delayed w/exertion post transplant lymphoproliferative disorder development of bronchiolitis obliterans transplant rejection
45
why can't pts feel the urge to cough post-lung transplant?
bc the nerve connections are cut during the procedure
46
why is there a change in voice post-lung transplant?
bc there is potential damage to nerves innervating vocal cords
47
why is the HR response delayed w/exertion post-lung transplant?
bc the vagus nerve that regulates it is cut
48
what is post transplant lymphoproliferative disorder?
a form of lymphoma from immune suppression and GI inflammation/ulceration of the stomach and esophagus
49
what is bronchiolitis obliterans?
obstruction of bronchioles due to inflammation
50
what are alternatives to lung transplant?
noninvasive ventilation or BiPAP lung volume reduction surgery (LVRS)
51
what is noninvasive ventilation or BiPAP?
delivery of positive airway pressure during inspiration and expiration indicated in pts w/signs of respiratory failure despite max drug and O2 therapy
52
what is lung volume reduction surgery (LVRS)?
20-30% of each lung is removed increases elastic recoil to improve efficiency of respiratory muscles and chest wall mechanics
53
clinical studies of LVRS demonstrate what benefits?
increase in FEV1, Decrease in FRC improved cardiac filling enhances VQ ratio decreased in CO2 retention decreased need for supplemental O2 use improvement of dyspnea and breathing pattern improved expiratory flow rates improved lung volumes increased exercise capacity as determined by 6MWT or maximal exercise
54
a majority of meds for heart and lungs transplants are what?
immunosuppressants and drugs targeting their side effects
55
what is induction therapy?
strong dose of immunosuppressants w/corticosteroids at the time of transplant
56
what are the advantages of induction therapy?
reduced rejection, decreased risk of bronchiolitis obliterans, 5-10 year increased survival for lung (not heart tho)
57
what are the disadvantages of induction therapy?
increased incidency of malignancy and infection, increased cost of transplant
58
t/f: the delayed rxn of the deneverated (donor) heart requires adequate warm up and cool down
true
59
what is a better measure of exercise intensity post heart transplant than HR?
RPE (rate of perceived exertion)
60
t/f: VO2 max makes great improvements post transplant
false, it remains well below predicted values even post surgery
61
what are factors that affect exercise post lung transplant?
exercise associated HTN muscles atrophy pre-transplant changes in muscle oxidative capacity suboptimal nutritional status deconditioning
62
t/f: you should avoid long periods of isometrics post-transplant
true

DPT 528 (9 decks)

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