[Anesthesiology experiences in 199 heart transplants]

From June 1983 to October 1987 199 orthotopic heart transplantations were performed at the Medical School of Hannover. Eighty percent of the organs were explanted in foreign hospitals. Since the cold ischemic time lasts less than 4 hours, a sophisticated transport system is essential. The selection of donors (dissociated brain death, age less than 35 years, systolic blood pressure greater than 70 mm Hg, intensive care for less than 7 days) and recipients (age between 10 and 55 years, final stage of irreversible myocardial insufficiency) is governed by strict criteria. A fixed pulmonary hypertension of more than 8 Wood is an absolute contraindication. The pulmonary wedge pressure and the right atrial pressure are preoperatively raised more than three times from normal. The ejection fraction is reduced to 10%. Seventy percent of the patients suffer from dilated cardiomyopathy. The premedication with flunitrazepam is given orally. Anaesthesia is induced with fentanyl and etomidate followed by pancuronium for intubation. During the time of induction all lines have to be inserted under sterile conditions. For weaning from the heart lung machine always catecholamines (isoproterenol, adrenaline) are applied in combination with vasodilators (nitroglycerin, DHB). Postoperatively patients will be extubated after 17.8 +/- 2.2 hours. Rejection episodes belong to the most threatening sort of complications. For this reason endomyocardial biopsies are done routinely.