Anesthetic protocol for right ventricular dysfunction management in heart transplantation: systematic review,...

Area of Science:

• Cardiology
• Anesthesiology
• Transplantation Medicine

Background:

• Right Ventricular Dysfunction (RVD) is a common and serious complication during Heart Transplantation (HTx), with high mortality rates.
• Current anesthetic management strategies for RVD lack consensus and validation.
• RVD affects 20-50% of HTx patients, posing significant intraoperative challenges.

Purpose of the Study:

• To develop and validate a standardized anesthetic protocol for managing Right Ventricular Dysfunction in Heart Transplantation.
• To provide anesthesiologists with a consensus-based, evidence-driven approach to RVD management.

Main Methods:

• A systematic review of 152 articles following PRISMA guidelines was conducted.
• Anesthetic management protocol was developed based on goal-directed therapy, invasive monitoring, and transesophageal echocardiography.
• The protocol was validated by six expert anesthesiologists using the AGREE II instrument, with a 70% minimum arbitration score.

Main Results:

• A six-step, flowchart-based anesthetic protocol for RVD management in HTx was created.
• The developed protocol received expert validation, indicating its potential utility.
• The systematic review identified key components for effective RVD management in HTx.

Conclusions:

• The expert-validated anesthetic protocol offers a structured approach to managing RVD in HTx.
• Further clinical studies are required to evaluate the protocol's applicability and impact on patient outcomes.
• This validated protocol represents a significant step towards standardized RVD management in heart transplantation.