Organ Transplantation

Question 1

What is a Cardiopulmonary Transplantation?

Answer 1

Simultaneous surgical replacement of the Heart and Lungs

Question 2

What are the causes of needing a Cardiopulmonary Transplantation?

Answer 2

• Congenital cardiac abnormalities with pulmonary hypertension
• Primary pulmonary hypertension with right Heart failure
• Sarcoidosis involving only the Heart and Lung

Question 3

What are some important transplant considerations?

Answer 3

• Limited available donor
• Donor must be brain dead with ventilator dependency
• Donor Heart and Lungs must be damage/disease free
• Donor and patient’s blood must match

Question 4

What is the window from a donor being removed from the ventilator?

Answer 4

There is a 45 minute window from when the ventilator is removed to when the donor must be declared deceased

Question 5

What is done to reduce the risk of reperfusion injury during the procurement of a Heart and Lung?

Answer 5

Heart and Lungs are flushed with:

• Cold electrolyte solution
• Collins solution
• Prostaglandin E-1 solution

All of this increases ischemia time to 6 hours

Question 6

What is Patient Positioning for a Cardiopulmonary Implantation?

Answer 6

Supine with Bilateral Arms tucked

Question 7

What incision is done when only the Heart is being implanted?

Answer 7

Midline Sternotomy

Question 8

What incision is done when both the Heart and Lungs are being implanted?

Answer 8

Clamshell incision

Question 9

Describe: Clamshell Incision

Answer 9

Bilateral incisions in the 4th Intercostal Space connected at the midline

Question 10

When does Cardiopulmonary Evisceration (removal from recipient) begin?

Answer 10

When the Heart and Lungs are physically in the Implantation OR

Question 11

Which nerves must be protected during a Cardiopulmonary Transplantation?

Answer 11

• Phrenic Nerve
• Vagus Nerve
• Recurrent Laryngeal Nerve

Question 12

What structure is anastomosed first when implanting the Heart and Lungs?

Answer 12

Trachea
-Done first to establish an airway

3-0 Prolene
- Running Stitch

Question 13

What suture is used to anastomose the Aorta during a Cardiopulmonary Transplantation?

Answer 13

4-0 Prolene

-Running stitch

Question 14

What suture is used to anastomose the Superior and Inferior Vena Cava during a Cardiopulmonary Transplantation?

Answer 14

3-0 Prolene

-Running stitch

Question 15

What are the steps after anastomosis is complete during a Cardiopulmonary Transplantation?

Answer 15

• Pleura closed over organs
• Drains placed
• Chest tubes inserted
• Sternotomy and incision are closed

Question 16

What are some drawbacks to a Cardiopulmonary Transplantation?

Answer 16

• Patient must take immunosuppressants for life

- Patient is highly susceptible to infection