[Early activation after orthotopic heart transplantation]

The purpose of the study was to analyze the authors' experience with early activation made in the operating-room in recipients after orthotopic heart transplantation (OHT). The study enrolled 12 patients (10 males and 2 females) aged 18 to 60 (41 +/- 5) years. OHT emergency corresponded to UNOS status 2 (n=9) and IB (n=3). The donors' age was 21 to 44 (35 +/- 3) years; the donor/recipient body weight ratio was 0.87 +/- 0.14; the least dopamine-induced cardiotonic support during conditioning was 4.7 +/- 0.4 microg/kg/min. The duration of myocardial ischemia was 106 to 237 (161 +/- 19) min. That of extracorporeal circulation (EC), surgery, and anesthesia was 66 to 129 (99 +/- 8) min, 4.5 +/- 0.3 and 6.2 +/- 0.5 hours, respectively. The induction of anesthesia used propofol 1.6 +/- 0.2 mg/kg, fentanyl 3.8 +/- 0.3 microg/kg, or rocuronium bromide 1.1 +/- 0.2 mg/kg. The maintenance of anesthesia in the preperfusion period was made with propofol (target concentration, 1.5 +/- 0.3 microg/ml), sevoflurane (1.4 +/- 0.3 vol %), and fentanyl. The mean use of propofol per surgery was 2.3 +/- 0.3 mg/kg/h; that of fentanyl and rocuronium bromide was 16.9 +/- 0.6 and 1.7 +/- 0.3 mg/ kg, respectively. In all recipients, the early posttransplantation period was characterized by stable central hemodynamics. At the end of surgery, cardiac index was 3.2 +/- 0.4 l/min/m2 during cardiotonic therapy: epinephrine 42 +/- 8 ng/kg/min (n=10), dopamine 6.4 +/- 0.7 microg/kg/min (n=12), or dobutamine 4.1 +/- 0.4 microg/kg/min (n=3). The interval between the end of surgery and tracheal intubation was 53 +/- 8 min. The duration of postoperative treatment in an intensive care unit was 2 to 4 (2.8 +/- 0.5) days. Thus, early activation can be made on the operating table after heart transplantation if there is no significant cardiac graft pump dysfunction or homeostatic disorders in recipients.