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DPT 528 > Heart and Lung Transplantation > Flashcards

Heart and Lung Transplantation Flashcards

1
Q

what is the 1 year survival rate of heart transplants?

A

86.2%

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2
Q

what is the 1 year survival rate of lung transplants?

A

83.6%

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3
Q

what is the 5 year survival rate of lung transplants?

A

53.4%

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4
Q

what is the 10 year survival rate of lung transplants?

A

28.4%

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5
Q

pts with a lung transplant usually do well for ____ years b4 complications/signs of failure

A

3-4

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6
Q

what is the primary indication for a heart/lung transplant?

A

progressive, terminal cardiopulmonary disease w/limited life expectancy

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7
Q

a majority of heart transplants are due to what diseases?

A

coronary artery disease

myocardial damage

cardiomyopathy

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8
Q

a majority of lung transplants are due to what diseases?

A

emphysema

idiopathic pulmonary fibrosis

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9
Q

t/f: failure of a transplanted organ is an indication for repeat transplant

A

true

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10
Q

referral for transplantation are indicated for patients…

A

who can survive on ionotropic meds (inc heart contractility) and mechanical support until transplant

end stage

frequent hospital readmissions for HF

worsening renal fxn

worsening R HF and rising pulmonary artery pressure from LV failure

frequent ventricular arrhythmias

anemia, weight loss, hyponatremia, liver dysfxn atrributable to HF

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11
Q

an urgent referral for transplant is indicated in pts with…

A

refractory cardiogenic shock w/max dose ionotropic treatment

refractory cardiogenic shock w/percutaneous mechanical circulatory support

refractory pulmonary edema not responsive to diuretics and requiring ventilation and positive pulmonary pressure

refractory ventricular arrhythmia not responding to medical therapy or electrophysiological procedures

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12
Q

what are contraindications for transplants?

A

active infection

chronic liver disease (cirrhosis)

advanced kidney disease (glomerular filtration rate <30 mL/min/1.73 m^2

recent stroke

symptomatic untreated PVD

uncontrolled DM w/end organ damage

active malignancy

severe lung disease (FEV1/FVC<50% predicted)

recent PE requiring anticoagulation (w/in last 3-6 months)

severe pulmonary HTN (systolic pressure >60mmHg)

lack of social support

disabling psychiatric illness

active smoking not willing to quit

non-compliance

morbidly obesity

multisystem disease

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13
Q

t/f: the age for being an organ donor is now over 65

A

true

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14
Q

most organ recipients are under ___ yo

A

59

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15
Q

what factors affect ranking on the transplant list?

A

tissue match

blood type

length of time of the list

immune status

distance bw potential recipient and donor

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16
Q

what test is often done to establish a baseline in transplant referrals?

A

6MWT

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17
Q

what is a left ventricular assist device (LVAD)?

A

bridge to transplant of heart many times

can be internal or external

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18
Q

what are the 4 surgical techniques for heart transplant?

A

1) heterotopic heart transplantation (HHT)
2) total transplantation
3) orthotopic heart transplant-bicaval
4) orthotopic heart transplant-biatrial

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19
Q

what is the heterotopic heart transplant technique?

A

rarely used

donor heart connected to native heart via R and L atria without removing the native heart

4 atria act as 2

pulmonary arteries are connected via Dacron tube graft

donor aorta anatomized to recipient aorta and donor pulmonary artery anastomosed to recipient pulmonary artery

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20
Q

what is the total transplantation heart transplant technique?

A

not frequently used
complete excision of recipient atrai w/complete AV transplantation, separate bicaval and pulmonary venous anastomoses

requires significant amount of time to complete (6 anastomoses)

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21
Q

what is the orthotopic heart transplant-bicaval technique?

A

bicaval anastomoses

donor and recipient hearts connected by sewing separate caval anastomoses

improved atrial fxn and lower rate of arrythmias

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22
Q

what is the distinguishing factor of orthotopic heart transplant-bicaval?

A

involved connecting the sup and inf vena cava of both the donor and recipient

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23
Q

what is the orthotopic heart transplant-biatrial technique?

A

donor and recipient atrial cuffs are sewn together

leaves the recipient SA node in tact

donor SA node operates independently of the recipient’s

2 separate P waves

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24
Q

in what heart transplant technique is the recipient’s SA node sensitive to sympathetic stimulation and will respond to increases in activation?

A

orthotopic heart transplant-biatrial

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25
Q

what are the complications of heart transplantation?

A

primary graft dysfxn

rejection

infection

delayed complications

cardiac allograft vasculopathy

malignancy

immunosuppressant related side effects

26
Q

what is primary graft dysfxn?

A

failure of the graft fxn within the 1st 24 hours

27
Q

what is rejection?

A

interaction bw recipient immune system and donor heart

mild rejection w/o donor heart dysfxn

severe rejection w/hemodynamic compromise

28
Q

why is infection a complication of heart transplantation?

A

bc the use of immunosuppressants increases the risk for infection

29
Q

when is the risk of death from infection post heart transplant the greatest?

A

1 year post-transplant

30
Q

t/f: live vaccines are contraindicated for heart transplant patients

A

true

31
Q

what is cardiac allograft vasculopathy?

A

the process that leads to narrowing/occlusion of coronary arteries of donor heart

significant cause of death in late post heart transplant

32
Q

t/f: the more time that has passed post-heart transplant the greater the incidence of cardiac allograft vasculopathy

A

true

33
Q

new onset of malignancies occurs in about __% of transplant pts after 1-5 years

A

10

34
Q

what are the factors for candidacy for a lung transplant?

A

end stage lung disease w/all other treatments used w/no improvements

pts with alpha-1 antitrypsin deficiency

pts w/ COPD

pts w/CF

pts w/idiopathic pulmonary fibrosis

pts w/pulmonary arterial HTN

pts w/sarcodoisis

35
Q

what are the contraindications for lung transplant?

A

concurrent chronic illness (renal, heart, liver)

current infection

current/recent cancer

current use of alcohol, tobacco, or illegal drugs

age

psychiatric conditions

hx of non-compliance

36
Q

what are the 4 surgical techniques for lung transplantation?

A

1) lobe
2) single lung
3) double lung
4) heart-lung

37
Q

what is a lobe surgical technique for lung transplant?

A

part of the donor lung replaces the diseases recipient lung portion(s)

38
Q

what is a single-lung surgical technique for lung transplant?

A

posterolateral thoracotomy

transplanting a single healthy lung

39
Q

what pt population often has a double lung transplant?

A

pts with CF due to bacterial colonization in both lungs

40
Q

how are donor lungs harvested?

A

pulmonary veins are detached from the heart w/cuff of the L atrium

pulmonary arteries are transected

the lungs are removed en bloc (all together) and then divided into R and L lungs

41
Q

what is the preferred procedure for lung transplantation?

A

use of the mainstem bronchial anastomoses

BL anterior thoracotomy or BL transsternal thoracotomy (clamshell incision)

42
Q

t/f: the least fxnal lung is removed and transplanted first

A

true

43
Q

there is improved post-op management and fewer complications due to the use of what?

A

hemodynamic monitoring devices

44
Q

what are the complications associated with lung transplants?

A

pt can’t feel the urge to cough when the lungs are congested

changes in voice

HR response delayed w/exertion

post transplant lymphoproliferative disorder

development of bronchiolitis obliterans

transplant rejection

45
Q

why can’t pts feel the urge to cough post-lung transplant?

A

bc the nerve connections are cut during the procedure

46
Q

why is there a change in voice post-lung transplant?

A

bc there is potential damage to nerves innervating vocal cords

47
Q

why is the HR response delayed w/exertion post-lung transplant?

A

bc the vagus nerve that regulates it is cut

48
Q

what is post transplant lymphoproliferative disorder?

A

a form of lymphoma from immune suppression and GI inflammation/ulceration of the stomach and esophagus

49
Q

what is bronchiolitis obliterans?

A

obstruction of bronchioles due to inflammation

50
Q

what are alternatives to lung transplant?

A

noninvasive ventilation or BiPAP

lung volume reduction surgery (LVRS)

51
Q

what is noninvasive ventilation or BiPAP?

A

delivery of positive airway pressure during inspiration and expiration

indicated in pts w/signs of respiratory failure despite max drug and O2 therapy

52
Q

what is lung volume reduction surgery (LVRS)?

A

20-30% of each lung is removed

increases elastic recoil to improve efficiency of respiratory muscles and chest wall mechanics

53
Q

clinical studies of LVRS demonstrate what benefits?

A

increase in FEV1, Decrease in FRC

improved cardiac filling enhances VQ ratio

decreased in CO2 retention

decreased need for supplemental O2 use

improvement of dyspnea and breathing pattern

improved expiratory flow rates

improved lung volumes

increased exercise capacity as determined by 6MWT or maximal exercise

54
Q

a majority of meds for heart and lungs transplants are what?

A

immunosuppressants and drugs targeting their side effects

55
Q

what is induction therapy?

A

strong dose of immunosuppressants w/corticosteroids at the time of transplant

56
Q

what are the advantages of induction therapy?

A

reduced rejection, decreased risk of bronchiolitis obliterans, 5-10 year increased survival for lung (not heart tho)

57
Q

what are the disadvantages of induction therapy?

A

increased incidency of malignancy and infection, increased cost of transplant

58
Q

t/f: the delayed rxn of the deneverated (donor) heart requires adequate warm up and cool down

A

true

59
Q

what is a better measure of exercise intensity post heart transplant than HR?

A

RPE (rate of perceived exertion)

60
Q

t/f: VO2 max makes great improvements post transplant

A

false, it remains well below predicted values even post surgery

61
Q

what are factors that affect exercise post lung transplant?

A

exercise associated HTN

muscles atrophy

pre-transplant changes in muscle oxidative capacity

suboptimal nutritional status

deconditioning

62
Q

t/f: you should avoid long periods of isometrics post-transplant

A

true

DPT 528 (9 decks)

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