test 8 patient selection, indications, and contraindications

Question 1

Patient Selection

Answer 1

 Patients have to be in end stage CHF
         NYHA function class III or IV
         Symptomatic refractory to management with medications, electrophysiology devices (pacemakers/AICD) and surgical intervention.
         LVEF < 35%
         Cardiogenic shock
                 Acute MI
                 Acute Myocarditis
         Ischemic heart disease
 Must be able to benefit from a transplant

Question 2

Contraindications

Answer 2

 Advanced age
 Irreversible pulmonary hypertension
 Active Infection and malignancy
 Obesity
 Diabetes
 Pulmonary Fibrosis, Emphysema, Hepatic and renal dysfunction, Cerebral vascular disease, Peripheral vascular disease
 Psychosocial

Question 3

Contraindications - advanced age

Answer 3

 Should be less than 65 years old
 Can be done in older patients
 Physiologic age is a better indicator than chronologic age.

Question 4

Contraindications - Irreversible pulmonary hypertension

Answer 4

 Pulmonary htn is a complication of CHF with elevated LVEDP.
 Can create irreversible changes to pulmonary vasculature
 Could cause RV failure in new organ because its pushing against a high pressure
 PA systolic above 50-60mmHg is not good!
 Give inhaled nitric oxide (iNO) to prevent pulmonary htn.

Question 5

Contraindications - Active Infection and malignancy

Answer 5

 Infections are exacerbated by immunosuppression required after transplantation.
 Need to be fever free for 72 hours
 Normal white cell count
 Negative blood cultures
 Hepatitis B, C, HIV not usually done
 HIV is becoming more acceptable to transplant due to improvement in drug therapy.
 Non-melanoma cutaneous cancers, primary cardiac tumors restricted to the heart, low grade prostate cancers
 Ok to transplant

Question 6

Contraindications - obesity

Answer 6

 Impacts infection rates, wound healing, and have an increased incidence of acute rejection.
 BMI less than 30 kg/m2

Question 7

Contraindications - diabetes

Answer 7

 Relative contraindication
 Control of blood sugars on steroids and immunosuppressant’s
 Wound healing

Question 8

Contraindications - Psychosocial

Answer 8

 Substance abuse (tobacco, alcohol)
 Compliance with medications
 Frequency of social support