test 8 perfusion perspective of heart transplant

Question 1

Things to happen before the heart is in the room

Answer 1

 Donor heart is located
 Patient will be in the room about the time the harvest team is at the donor site.
 Harvest team will be able to view the heart. Once they view a TEE and visualize – will call the OR.
 Patient will be induced.
 Harvest team will call saying “heart is out”.
 Write down donor cross clamp time. This is the start of the ischemic period of the donor organ.
 Patient will be draped. If it’s a redo, incision will be made with the “heart out” call.
 Median sternotomy
 If it’s a redo, you’ll go on Fem-fem.

Question 2

Things that happen when the heart is in the room

Answer 2

 Heart is in the room
 Go on bypass. Usually drift, or cool to about 32*C. Cross clamp almost immediately.
 Recipient’s diseased heart is removed.
 Cardioplegia not usually given.
 Surgeon will go to the back table to trim the donor heart.
 Donor heart is moved into position in the chest.
 Donor heart is sewn in.
 Rewarm
 Sutures complete.
 Some institutions give a “hot shot” type dose of “cardioplegia”. Use Glutamate Aspartate Solution. Full of nutrients for that ischemic heart. Other places don’t.
 Cross Clamp off
 Pacing wires placed
 Fill up heart
 Wean from CPB.
 Close