Key messages

• While postoperative care of the heart transplant recipient remains unique in many ways, it also shares many of the management issues for patients following routine cardiac surgery.

• Hearts used for transplantation have normal ejection fractions and no significant coronary artery disease by donor selection criteria. Therefore an adequate preload should result in adequate cardiac output.

• Because of hypothermic preservation or possible ischemia-reperfusion injury, the rate of the denervated heart may be as slow as 40 to 50 beats/min. In order to ensure an acceptable heart rate, and hence an acceptable cardiac output, patients receive continuous intravenous infusion of b-adrenergic agonists for several days following transplantation.

• The right ventricle may fail as a sequela of acute vascular or cellular rejection. Acute right ventricular failure should be suspected if hypotension, low cardiac output, and elevated central venous pressures exist postoperatively.

• Arrhythmias or new evidence of congestive heart failure should alert the physician to possible acute cellular rejection.

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