医药-心脏移植.pptVIP

Graft vascular disease (GVD) Infection Long-term follow-up Question Are there any differences in the incidence of graft rejection between adult and teenagers, especially infant? Tel: Email: doctorlqz@163.com * * * * Preoperative treatment Surgery Procedure Perioperative care Patient management Preoperative treatment Reverse heart failure Improve living quality Prolong living time Sustain the recipient’s life until the transplantation Preoperative Medicine treatment Diuresis （Furosemide） Reduction of myocardial oxygen consumption (β-blocker) Reconstructing?cardiac muscular?structure （ACEI or ARB） ? Preoperative Life assistant Artificial heart Ventricular assistant device, VAD ECMO Surgery procedure Donor heart harvest Surgery procedure Donor heart preservation Cardioplegia: HTK solution, UW solution, Hypothermic preservation Continuous perfusion limit of cold ischemia Pancreas 20h Kidney 25h Liver 12h Heart 6h Surgery procedure Surgery procedure Recipient cardiectomy Biatrial procedure Bicaval procedure Surgery procedure Cardiac implantation (Bi-atrial) Surgery procedure Cardiac implantation (Bi-caval) Surgery procedure Cardiac implantation (Bi-caval) Postoperative care Inotropic support inotropic support and pacing, if needed, is weaned over 2–3 days to allow the RV to slowly adapt to high afterload Echocardiography is used extensively to guide the therapy. Isoproterenol is weaned off over the course of 24–48 hours, starting on postoperative day 2, while maintaining a heart rate of greater than 100 beats/minute. Postoperative care Special consideration is given to facilitate early extubation and removal of intravenous lines, tubes, and catheters. Further management continues in a telemetry ward, where aggressive physical therapy and ambulation is instituted. If the patient has an uncomplicated postoperative course, he or she is routinely disch