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Table 2 Selection criteria for heart transplantation recipients

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. The similarities between heart bypass and heart transplant surgery in the immediate postoperative period include optimizing hemodynamics, weaning from mechanical ventilatory support, and achieving adequate hemostasis.

The unique nature of caring for patients following heart transplantation is due, in part, to lack of sympathetic or parasympathetic innervation of the heart. Because of this, special attention needs to be paid to adequacy of heart rate in maintaining cardiac output, need for pacing, and which antiarrhythmic agents are effective. Additionally, issues such as intensity and types of immunosuppression, diagnosis and treatment of rejection, and prevalence of postoperative infectious and general surgical complications make the care of heart transplant recipients potentially much more complicated than that of other cardiac surgical patients. Here we address these subjects as well as some of the long-term sequelae that send heart transplant recipients back to the critical care setting, such as transplant coronary artery disease and post-transplant lymphoproliferative disease.

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