Perioperative care of heart transplant recipients undergoing non-cardiac surgery.
Perioperative care of heart transplant recipients undergoing non-cardiac surgery.
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DOI：
10.4103/aca.aca_130_19
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发表时间：
2021-04
影响因子：
0.9
通讯作者：
Modak RK
中科院分区：
文献类型：
--
作者：
Navas-Blanco JR;Modak RK
自1967年首次引入医疗实践以来，近几十年来接受原位心脏移植（OHT）的终末期心脏病患者的预期寿命显著增加。术后重症监护、手术预防和抗排斥药物的显著进步明显影响了OHT后的生存率，因此，预计未来几年接受非心脏外科手术的患者数量将继续增加。需要进行非心脏手术的OHT后患者的激增有许多注意事项，包括就诊于没有管理潜在围手术期并发症所需的资源和技术的医疗机构，或者可能不熟悉这些患者的护理，没有心脏麻醉师的医疗机构，需要进行紧急手术的患者等。OHT后患者的围手术期护理给麻醉师带来了一些挑战，包括不同于一般人群的术前风险评估和对药物反应和药物相互作用改变的失神经支配器官的术中管理。本综述旨在概述OHT后非心脏手术患者的当前数据，可能影响围手术期护理的移植手术方面，移植心脏的生理学以及麻醉考虑。
The life expectancy of patients with end-stage heart disease undergoing Orthotopic Heart Transplantation (OHT) has increased significantly in the recent decades since its original introduction into the medical practice in 1967. Substantial advances in post-operative intensive care, surgical prophylaxis, and anti-rejection drugs have clearly impacted survivability after OHT, therefore the volume of patients presenting for non-cardiac surgical procedures is expected to continue to escalate in the upcoming years. There are a number of caveats associated with this upsurge of post-OHT patients requiring non-cardiac surgery, including presenting to healthcare facilities without the resources and technology necessary to manage potential perioperative complications or that may not be familiar with the care of these patients, facilities in which a cardiac anesthesiologist is not available, patients presenting for emergency procedures and so forth. The perioperative care of patients after OHT introduces several challenges to the anesthesiologist including preoperative risk assessments different to the general population and intraoperative management of a denervated organ with altered response to medications and drug-drug interactions. The present review aims to synopsize current data of patients presenting for non-cardiac surgery after OHT, surgical aspects of the transplant that may impact perioperative care, physiology of the transplanted heart as well as anesthetic considerations.