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Keywords

 

Authors

  1. Barkley, Michelle L. RN, BSN, CCRN
  2. Acosta, Julie D. RN, BSN
  3. Starin, Elvira RN, ADN
  4. Tan, Melissa C. RN, BSN

Abstract

Cardiac transplantation is a recognized and lifesaving treatment for those unresponsive to all other available treatments (Hosenpud JD, Bennett LE, Kech BM, Boucek MM, Novick RJ. The registry of the International Society for Heart and Lung Transplantation: eighteenth official report-2001. J Heart Lung Transplant. 2001;20:805-815). The number of transplants performed in the United States grows steadily yearly with improving drugs for infection and rejection, the 2 most common medical complications and still the primary causes of death in long-term follow-up (Zugibe F, Costello J, Breithaupt M, Segalbacher J. Model organ description protocols for completion by transplant surgeons using organs procured from medical examiner cases. J Transplant Coord. 1999;9:73). Sometimes, getting the patient to the transplant process is in itself a struggle. As the need for heart transplants increase across the nation, donor hearts have not increased, even with more awareness in the medical community. Therefore, our struggle remains with keeping the patient alive, stable, and in the best position for transplantation when the perfect donor heart arrives. As critical care nurses, we see this bridge to transplantation in the form of pharmaceutical agents and/or mechanical assist devices (Scherr K, Jensen L, Koshal A. Mechanical circulatory support as a bridge to cardiac transplantation: towards the 21st century. Am J Crit Care. 1999;8:324-337). The patient waits patiently for a donor heart to be available, but is becoming weaker in the process. We wish to see those hearts come sooner and healthier. In truth, this in not usually seen. Sometimes the wish comes true, and with the help of nurses, doctors, ancillary departments, and even multiple hospital systems pulling together a miracle can still happen.

 

AMOMENT away from death, at times only clinging to life, he struggled through surgery after surgery. He underwent heart surgery to repair a valve, emergency heart bypass system, 2 separate ventricular assist devices (VADs), multiple cardiac surgeries, and finally, a cardiac transplant; he had truly become the "Whitman Sampler" of cardiac procedures. Now, because of this new life given to him, he has begun a new life. On June 25, 2003, Avimael and his wife completed their family of 5 with a new life, a 10.4 lb baby girl.

 

Avimael's struggle began on August 19, 2001 as a routine Ross procedure (The aortic valve is replaced by his pulmonary valve and his pulmonary valve then replaced by an aortic homograft). As he rolls into the Transplant ICU (TICU) postoperation, he goes into cardiogenic shock and has a cardiac arrest. His surgeon rushes to his side, struggling to keep him alive. Residents, nurses, and students all work in a coordinated effort to bring this young man back to his waiting wife and 2 small children. A perfusionist sets up CPS (Cardiopulmonary bypass system) at the bedside while the surgeon inserts the cannulae to the femoral artery and vein. He threads the venous cannula through the vein, to the inferior vena cava, resting at the junction of the inferior vena cava and the right atrium (RA). It is now in the perfect position to draw blood from the right atrium by revolutions per minute (RPMs) to the blood pump, which will act as the patient's heart. As the perfusionist primes the circuit consisting of the pump head and oxygenator, the surgeon is now placing the arterial cannula to the femoral artery and threading up the aorta. It will rest in the ascending aorta, sending its well oxygenated arterial blood flow up the aorta to perfuse the coronaries, brain, kidneys, and systemic circulation. Once the cannulae are placed, the surgeon then connects the primed circuit to these cannulae, unclamps, and slowly begins circulation back to the now still heart and lungs. The blood flow is now diverted from the RA to the pump head, through the oxygenator and back into the body. As the cardiac flows increase, perfusion to all vital organs resume. 1