Anesthetic Management of Pediatric Cardiac Transplantation

Abstract

Cardiac transplantation has become a widely accepted ther apy for a variety of end-stage cardiac diseases in pediatric patients. From November 1985 to November 1999, 347 pe diatric cardiac transplantations were performed at Loma Linda University Medical Center (LLUMC), including 235 in children younger than 6 months of age. It is essential to be familiar with the physiologic and anatomic characteristics of the recipient. Hypoplastic left heart syndrome is the most frequent congenital disorder leading to transplant in neo nates at LLUMC, with diseases presenting with left ventric ular failure accounting for the majority of the remainder of patients. We have assessed many variables for a possible relationship to intraoperative or postoperative compli cations, including anesthetic induction and maintenance agents, pH and base excess, as determined by arterial blood gas analysis before cardiopulmonary bypass (CPB), and he modynamic changes requiring treatment before CPB. Al though we have noticed an association between low patient temperature or mechanical stimulation at the time of ster notomy, and hemodynamic complications before CPB, in our experience no single anesthetic technique or intraoper ative event, including ventricular fibrillation, predicts early mortality. We believe anesthetic management of pediatric cardiac transplant recipients should be tailored to fit the pathophysiology present.