Postoperative Management

As a result of the ischemic insult, the transplanted heart exhibits depressed systolic function and impaired contractility. To assure adequate cardiac output, preload must be maintained with right atrial pressures of 10-15 mm Hg and left atrial pressures of 15-20 mm Hg. Aside from recovering from the preservation ischemia, the transplanted heart is totally denervated. As a result, there are significantly altered responses to cardiovascular drugs (Table 11.4). As a result of the denervation, the most commonly used inotropic agent is isoproterenol in doses of 0.25 to 5.0 mcg/min. If further inotropic support is needed dobutamine or epinephrine may be used. Dopamine is primarily used to enhance renal perfusion. Inotropic support is usually required for 2-3 days postoperatively.

Denervation also alters the use of antiarrhythmic agents. Digoxin is of little use since its antiarrhythmic properties are vagally mediated. Quinidine or procainamide are typically used for supraventricular and ventricular tachyarrhythmias. Verapamil is also used to manage supraventricular tachyarrhythmias. Lidocaine is effective for ventricular arrhythmias.

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