[Complications and problems of acute care in patients undergoing heart transplantation]

We have experienced 20 cases of heart transplantation at the National Cardiovascular Center. We are discussing postoperative complications and intensive care for those cases. Hemodynamic problems may be summarized as the denervated heart, transient cardiac dysfunction, pulmonary hypertension in the recipient's pulmonary circulation, and donor-recipient size mismatch. In a case with donor-recipient size mismatch, cardiogenic pulmonary edema developed immediately after the tracheal extubation, probably due to wound pain and afterload mismatch. In all patients, weaning from mechanical ventilation was smooth. Prolonged mechanical ventilation seemed to result from a delay in awakening, hemodynamic instability, lactic acidosis, and donor-recipient size mismatch. Acute renal insufficiency occurred in 8 patients, while 1 patient needed 12 hours of continuous hemodiafiltration. All of the patients received infusions atrial natriuretic peptide and restored renal insufficiency.