Learning objectives

• Describe the hemodynamic implications of a transplanted heart
• Manage patients with a transplanted heart undergoing non-transplant surgery

Definition & mechanisms

• Cardiac transplant is the treatment of choice for many patients with severe cardiac failure who have failed medical therapy
• A transplanted heart has an absence of sensory, sympathetic, and parasympathetic innervation
• Due to a lack of parasympathetic innervation, vagal tone is lost and the resting heart rate will be 90–110 bpm
• Cardiac output of the transplanted heart is relatively dependent upon preload
• In response to hypovolemia, the cardiac output is increased by increasing the stroke volume rather than the heart rate and contractility, due to insensitivity to neurohormonal stimulation
• A degree of sympathetic and parasympathetic innervation develops with time (3+ years)
• The ECG in 80% of recipients will demonstrate two p-waves due to the posterior portion of the atrial walls being retained from the original heart

Management

Suggested reading

• Pollard BJ, Kitchen, G. Handbook of Clinical Anaesthesia. Fourth Edition. CRC Press. 2018. 978-1-4987-6289-2.