mechanical assist device # 2 Flashcards
Relative VAD contraindications
Age > 70 Congenital heart disease chronic renal failure symptomatic cerebrovascular disease COPD Blood/bleeding disorders bacterial endocarditis malignancy or other disease causing an expected survival < 2 years any contraindication to transplant
List possible VAD candidates
Transplant candidates Corrected metabolic abnormalities (temp, pH, and electrolytes) Good Neurological function absence on infection absence of coagulopathy or GI bleed absence of signficant lung disease
What 3 lesions do you need to fix when implanting a VAD
PFO–closed to prevent R-L shunting and cyanosis
Mitral stenosis—might need to do a valvotomy to improve LVAD inflow. If MVR use a bioprosthesis
Aortic insufficiency/either replace or oversew. Mechanical valve has to be replaced or oversewn.
List absolute contraindications to cardiac transplant
Pulmonary hypertension Transpulmonayr gradient > 15mmHg systolic pulmonary artery pressure > 50 Pulmonary vascular resistance > 4 Pulmonary vascular resistance index > 4 Renal dysfunction Active infection DM with end order dysfunction
What are characteristics of brain death
Absence of Brain stem reflexes
Cough +/- pharyngeal reflexes
Corneal reflexes
Occulocephalic reflex (Doll’s eyes)
Occulovestibular reflex
Apnea test for minimum of 8mins showing no resp movements and pco2 60
Absence of response to pain
Ensure no metabolic disturbances, pharmacoogic agents, and hypothermia
Clinical evidence of CNS catastrophe compatible with brain death
What are advantages of Bicaval anastomosis in transplant
decreased incidence of atrial arrhythmias and conduction decreased incidence of MR and TR improved preservation of atrial geometry decreased dependence on diuretics decreased post operative RV failure decreased length of stay better 1 year survival
What is CMV
Member of herpes virus family
Can be a new infection or a reactivation of latent infection
What are effects of CMV infection
It has both direct and indirect effects on recipient resulting in increased morbidity and mortality
Direct Heptatitis gastroenteritis colitis Pneumonia Indirect Allograft injury-lead to acute rejection and cardiac allograft vasculpathy PTLD
What are effects of CMV infection
It has both direct and indirect effects on recipient resulting in increased morbidity and mortality
Direct Heptatitis gastroenteritis colitis Pneumonia Indirect Allograft injury-lead to acute rejection and cardiac allograft vasculpathy PTLD
What is treatment for CMV prevention and active infection
If pt seropositive then treat with gancyclovir for about 30 days
If pt seronegative pts do no benefit from treatment but some people still give it
If active infection then 2-4 weeks of gancyclovir + hyperimmune globulin
Indication for LVAD as bridge to transplant
Potential transplant candidate + absence of major contraindications (Sepsis or Columbia score > 5).
acute, failure of maximal medical therapy (IABO + inotropes)
Cardiogenic shock
post-cariotomy
post MI
myocarditis
peripartum cardiomyopathy
Chronic
acute decompensated heart failure
chronic heart failure
intractable ventricular arrhythmias despite maximal medical therapy
4 indications for LVAD as bridge to transplant
Indications patient is a transplant candidate CI < 2.0 u/o < 20 ml/hr PCWP > 20 mmHG Systolic BP < 80 mmHg
List contraindications to LVAD
sepsis
anuria
CVP < 16
Revised Columbia score > 5 (mortality 47% if score > 5)
What is Columbia scoring of risk for LVAD insertion
Ventilated ---4 points Redo surgery --- 2 Lrevious LVAD --2 points CVP > 16 1 PT > 16 seconds
Absolute contraindications to accepting a donor heart
Viral infection: HIV, HTVL, Hep B, systemic viral illness (measles, adenovirus, rabies, enterovirus
Active malignancy or recent malignancy (excluding supretentorial lesions)
Prior MI
Intractable or recurrent ventricular arrhythmias
Significant structural heart disease
myocardial contusions
valvular heart disease
severe LVH
Coronary artery disease
