Transplant Cardiology Flashcards
Post Cardiac Transplant Survival
> 85% at 1 year
70% at 5 years
50% at 10 years
Transplant candidates
Cardiopulmon VO2 <14ml/kg/min (<12 on BB) despite OMT (best way to check prognosis to determine candidate for transplant)
Resp exchange ratio >1.05 = max effort
If <50yo use <50% expected VO2
Other tests for HF candidacy
Seattle HF test underestimates risk
6 MWT doesn’t work as well
Triggers for Tx Eval
Frequent hospitalizations
Cardiorenal syndrome
poor fxn status on OMT
Contraindications to Heart Tx
No family support substance abuse Pulm HTN advanced age obesity poor renal fxn
LVAD
1) Bridge to transplant
- severe decompensated HF despite ionotrope
- phenylephrine not ok (just inc’s SVR/afterload, no change to contractility and will dec CO)
- no sildenafil as will inc pulm flow and inc’d PCWP/left heart filling
MC Cause of death
30 days - Primary graft failure (older donor age, ischemic time)
1 year - cellular rejection
Malignancy/vasculopathy - long term…
Hyperacute - minutes to hours - preformed donor specific antibodies in receipient
Acute cellular rejection - 2-3 months