Pediatric cardiac transplantation and anesthesia

Orthotopic cardiac transplantation is the standard of care for end-stage heart disease in children. The causes are age dependent; the most common cause being congenital heart disease in infants and dilated cardiomyopathy in older children. The complexity of the recipient's disease, surgical history and the hemodynamic instability in which these patients can present mandates a thorough preoperative assessment and coordination of an intraoperative plan. Intraoperatively, maintenance of an adequate preload, normal/elevated heart rate, preserved myocardial contractility, avoiding increase in systemic vascular resistance and maintaining a normal/low pulmonary vascular resistance are crucial in order to maintain hemodynamic stability. Postoperatively, the unique physiologic characteristics of the transplanted heart must be considered. Finally, immunosuppression and surveillance in these patients are crucial to minimize postoperative morbidity and increase their long-term survival.