HEART TRANSPLANT

Question 1

What is an orthotopic transplant?

Answer 1

The client’s heart is replaced by a donor’s heart

Question 2

What is a heterotopic transplant also known as?

Answer 2

Piggy back heart

Client’s heart + Donor’s Heart
To support the poor function of client’s heart

Question 3

What are the indications for heart transplantation?

Answer 3

CNI

Cardiac disease symptoms unmanageable by conventional medical therapy

No surgical options offering more favorable long term outcome

Individual’s short-term prognosis is poor without transplantation

Question 4

What is the upper age limit for heart transplant candidates?

Answer 4

70 years old

Question 5

List the ABSOLUTE medical contraindications for heart transplantation.

Answer 5

EIKCRAA

Elevated pulmonary artery pressures

Irreversible severe renal, hepatic, or pulmonary disease

Kidney dysfunction

Chronic liver dysfunction

Recent or unresolved pulmonary infarction

Active uncontrolled infection

Active malignancy or recent malignancy with high risk of recurrence

Question 6

What are the RELATIVE medical contraindications for heart transplantation?

Answer 6

ADOSSSHH

Advanced age (>70 years)

Diabetes mellitus with end-organ damage and/or poor glycemic control

Obesity

Severe cachexia or malnutrition

Systemic disease with high probability of recurrence

Severe peripheral vascular disease or cerebrovascular disease

History of multiple prior sternotomies

High level of allosensitization

Question 7

How are heart transplant candidates prioritized?

Answer 7

Based on Medical urgency:

INHMM

Inotropic support
Hemodynamic Monitoring
Mechanical Ventilation
Mechanical assist device

Question 8

Donor heart is prepared by interconnecting pulmonary veins, trimming aorta and pulmonary artery, removing recipient’s heart except posterior atrial walls, and performing four major anastomoses

Right atria
Left atria
Aorta
Pulmonary artery

Answer 8

Biatrial Technique

Question 9

What is the disadvantage of the biatrial technique?

Answer 9

Increased risk of MAAT

Mitral and tricuspid valve regurgitation

Atrial septal aneurysm

Atrial thrombus formation

Tachydysrhythmias

Question 10

What does the bicaval technique preserve?

Answer 10

SA node function

Question 11

What are the benefits of the bicaval technique?

Answer 11

PDR

Preserved SA node function

Decreased incidence of atrial dysrhythmias

Reduced mitral and tricuspid regurgitation

Question 12

What is a priority nursing diagnosis post heart transplant?

Answer 12

Decreased Cardiac Output

Question 13

What is the gold standard for rejection surveillance in heart transplantation?

Answer 13

Endomyocardial biopsy

Question 14

What is the common treatment for acute rejection episodes?

Answer 14

IV corticosteroids

Question 15

What are some strategies for treating recurrent rejection?

Answer 15

Augmenting maintenance immunosuppression

Switching to alternatives: Tacrolimus, Mycophenolate Mofetil, or Rapamycin

Using polyclonal antibodies:
*Anti lymphocyte globulin
*Anti thymocyte globulin

Question 16

What should be done if a development of fever occurs post heart transplant?

Answer 16

Aggressively investigate, including blood, wound, respiratory cultures, and chest radiographs

Question 17

What is considered a significant elevated temperature post heart transplant?

Answer 17

38° C (100.4° F)

Question 18

What antiviral agent is used for prophylaxis and treatment of Cytomegalovirus (CMV) infections?

Answer 18

Ganciclovir

Question 19

True or False: Acute cellular rejection in heart transplant recipients is most likely to occur during the first 3 to 6 months after transplantation.

Answer 19

True

Question 20

Fill in the blank: Heart transplant recipients can range from ______ to patients in their 60s.

Answer 20

[neonates]