Anesthetic management of pediatric cardiac transplantation

Cardiac transplantation has become a widely accepted therapy for a variety of end-stage cardiac diseases in pediatric patients. From November 1985 to November 1999, 347 pediatric 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 neonates at LLUMC, with diseases presenting with left ventricular failure accounting for the majority of the remainder of patients. We have assessed many variables for a possible relationship to intraoperative or postoperative complications, including anesthetic induction and maintenance agents, pH and base excess, as determined by arterial blood gas analysis before cardiopulmonary bypass (CPB), and hemodynamic changes requiring treatment before CPB. Although we have noticed an association between low patient temperature or mechanical stimulation at the time of sternotomy, and hemodynamic complications before CPB, in our experience no single anesthetic technique or intraoperative event, including ventricular fibrillation, predicts early mortality. We believe anesthetic management of pediatric cardiac transplant recipients should be tailored to fit the pathophysiology present. © 2001 by W.B. Saunders Company.