Abstract
While considerable progress is being made in the medical management of heart failure, mortality for this disease process continues to be significant. Cardiac transplantation becomes the treatment of choice for those with end-stage diseases that are acceptable candidates. While care of the cardiac transplant patient is similar to those recovering from cardiopulmonary bypass after sternotomy, there are several issues unique to the cardiac transplant recipient. These include cardiac denervation, allograft dysfunction, management of arrhythmias, rejection, immunosuppression, and infectious complications. This article provides an overview of the postoperative management of the cardiac transplant recipient while in the intensive care unit. Additionally, a brief description of the surgical techniques employed and the physiology related to cardiac denervation are presented.
THE INCIDENCE of end-stage heart failure is rising in the United States. According to the American Heart Association Heart Disease and Stroke Statistics 2003 Update, the prevalence of heart failure in the United States for the year 2000 was 4,900,000. Five hundred fifty thousand new cases were diagnosed; 51,546 died; and the national expense associated with the care of these patients exceeded $24.3 billion. 1 Many advances in medical therapy for heart failure have been made in the past decade; however, there continues to be a continued need for donor hearts for transplantation. Recent advances in mechanical assist devices give researchers hope that these devices will aid in bridging patients to transplantation, or offer a long-term alternative to transplantation. It is, however, unlikely that these therapies will replace the need for heart transplantation.