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CH. 12 Thoracic Organ Transplantation
Heart, Lung, Heart-lung Final Material
74
Medical
Graduate
04/26/2012

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Term
What does heterotopic transplantation mean?
Definition
2 hearts in the body at the same time
Term
What does orthotopic transplantation mean?
Definition
Take the bad heart out and put the good/new one in
Term
What is the primary indication for a thoracic organ transplantation?
Definition
Progressive terminal cardiopulmonary dz with limited life expectancy
Term
Name the top 3 reasons in which the majority of heart transplants are performed.
Definition
1. CAD
2. Myocardial damage
3. Cardiomyopathy
Term
The majority of lung transplants are performed in patients with what?
Definition
Emphysema
Term
This is an indication for heart and lung repeat transplantation
Definition
Failure of transplanted organ
Term
What all has to be done for a person to be a candidate for a transplantation
Definition
1. an evaluation must occur for acceptance onto the transplant list
2. candidate must be able to comply with a complicated medical regimen and have sufficient social support
3. style of coping with stressors inherent in waiting period may predict aspects of QOL
4. caregiver stress
5. results of eval is compiled by a transplantation coordinator
Term
What kinds of factors affect the ranking in which the person is placed on the transplant list?
Definition
Tissue Match
Blood Type
Length of time on list
Immune status
Distance between recipient and donor
Term
The priority of lung transplantation list in maintained by who?
Definition
UNOS
Term
Recipient of what age or younger are ranked first by ABO blood status?
Definition
12 y/o
Term
What type of score are the pts provided with that determines their priority on the transplant list?
Definition
LAS
Lung Allocation Score
Term
List the 5 parts to the PT eval related to lung transplant
Definition
1. Similar to any cardiopulmonary medical or surgical pt
2. Lung transplantation candidate - need to assess efficacy of airway clearance techniques
3. Assessment of aerobic capacity / endurance with exercise and activity using maximal test
4. Test results serve as basis for prescribing a program and provide useful info to the transplantation team
5. Exercise may be contraindicated in pts with primary pulmonary hypertension
Term
Most lung centers require participation of candidates in what?
Definition
pulmonary rehab
Term
Recommendation of _ rehab is made on an individual basis
Definition
cardiac
Term
Name some components of the preoperative rehab
Definition
Pt/family education
cardiovascular endurance training
musculoskeletal strength
Term
What is the goal of preoperative rehab?
Definition
Improve or prevent deterioration of candidate's physical condition
Term
In preoperative rehab, typically the level of participation in endurance activities will be limited to minimal levels of what?
Definition
exertion or just ADLs
Term
This device is used to bridge the pt
Definition
LVAD
Left Ventricular Assistive Device
Term
How often are most pts able to participate in exercise in the preoperative rehabilitation?
Definition
30-40 min
3-5 x/week
Term
Name 4 factors related to transplant unsuitability
Definition
1. Pt did not meet criteria for organ system failure
2. Presence of contraindications limits potential for success
3. Decreased overall benefits for the pt from transplantation
5. Pt opted for more conservative surgical or medical management
Term
With lung volume reduction surgery, how much of the lung is removed?
Definition
20-30% of volume of each lung
Term
What is the goal of lung volume reduction surgery?
Definition
To improve thoracic distention and chest wall mechanics
Term
What do the results of the national emphysema treatment trial depend on?
Definition
exercise capacity and what lobe is involved
Term
Name the 4 categories for the national emphysema treatment trial
Definition
1. Low ex capacity / Upper lobes
2. High ex capacity / Upper lobes
3. Low ex capacity / Lower lobes
4. High ex capacity / Lower lobes
Term
This results in a lower mortality rate with LVRS
Definition
Low ex capacity / upper lobes
Term
This shows no difference in mortality, but better outcomes
Definition
High ex capacity / upper lobes
Term
This results in a similar mortality rate
Definition
Low ex capacity / lower lobes
Term
This results in a higher mortality with LVRS
Definition
High ex capacity / lower lobes
Term
A tightly fitting nasal mask to deliver positive airway pressure during inspiration and exhalation. Indicated for pts with signs of respiratory failure despite maximal drug and O2 therapy
Definition
Noninvasive ventilation or BiPAP
Term
Pt with this tend to deteriorate in medical status quickly
Definition
Cardiac ms dysfunction
Term
Pt with this tend to
Definition
Term
Implantable electrically power device that provides permanent support of systemic circulation. Pt typically is able to resume ADLs and exercise program
Definition
LVAD or BiVAD
Term
Destination VAD - patients who have __ year life expectancy, not a candidate for tranplantation
Definition
<2
Term
Fatigue-resistance skeletal ms is wrapped around the pts heart and stimulated electrically
Definition
Cardiomyoplasty
Term
Also known as piggyback. This is where the native heart is not removed. The donor heart is connected to the native heart via right/left atria
Definition
Heterotopic
Term
The complete excision of the recipient atria with complete atrioventricular transplantation, bicaval and pulmonary venous anastomoses
Definition
Total Transplantation
Term
Biatrial anastomoses whereby donor and recipient atrial cuffs are sewn together
Definition
Biatrial Technique
Term
This leaves the recipient SA node intact, which remains functional; donor heart SA is denervated. Two separate P waves are seen on ECG
Definition
Orthotopic
Term
With a heart transplant, the pts nerves are denervated so they can no longer feel chest pain. What can they do to be aware of chest pain or discomfort in the future?
Definition
Look for other signs and symptoms such as diaphoresis, SOB, or dyspnea on exertion
Term
Name 3 ways to harvest donor lungs
Definition
1. Pulmonary veins are detached from heart with cuff of left atrium
2. Pulmonary arteries are transected
3. Lungs removed en bloc, divided into separate right and left lungs
Term
What is the preferred procedure for lung transplantation?
Definition
Use of mainstem bronchial anastomoses, bilateral anterior throacotomies or transsternal bilateral thoracotomy (clanshell)
Term
What type of thoracotomy is done for a single lung transplant?
Definition
Posterolateral
Term
If the heart is denervated, how will the heart know when to increase because the pt is exercising?
Definition
Catecholamine circulation. This is why cool down is very important and needs to be done longer because you should give your body enough time to realize it is done exercising and decrease the catecholamines
Term
The majority of medications consist of ___ agents and drugs targeting side effects of these agents
Definition
Immunosuppressive
Term
This regimen in necessary to prevent rejection of the donor organ.
Definition
immunosuppressive
Term
Induction therapy is where you get a strong dose of immunosuppressives. What are some advantages of this?
Definition
Reduce rejection, decrease risk of briochiolitis obliterans (which is a long term complication of transplants)
Term
Induction therapy is where you get a strong dose of immunosuppressives. What are some advantages of this?
Definition
Reduce rejection, decrease risk of briochiolitis obliterans (which is a long term complication of transplants)
Term
What are some disadvantages of induction therapy?
Definition
Increase incidence of malignancy and infection; increase the cost of transplantation
Term
Name 3 things to watch for as the pt responds to activity postoperatively.
Definition
1. Note pt had undergone a major change in cardiovascular physiology
2. Understanding the change in physiology allows for proper application of precautions
3. Common changes include improvements in hemodynamic function
Term
This initially occurs following heart transplant; infrequent with isolated lung transplant
Definition
Cardiac denervation
Term
What does HHT mean?
Definition
Donor heart responds in the same manner as the denervated heart; native heart is still innervated, but attention should be on the donor hearts response
Term
After transplantation, why is there a delayed reaction of the denervated heart?
Definition
it requires an adequate warm-up and cool down (catecholamine)
Term
After a heart transplant, HR monitoring no longer an an accurate measure of exercise intensity, so what is?
Definition
RPE (want it between 12 and 14
Term
After a heart transplant, what is the importance of monitoring BP during exercise?
Definition
HTN is a concern due to likelihood of developing ischemia
Term
Does HTN occur after lung transplant?
Definition
Yes, but lower incidence than heart transplant
Term
After __ transplant, maximum O2 uptake and exercise capacity improve significantly, but still remain below predicted values
Definition
Lung
Term
After transplant, exercise will be limited mainly due to what 6 things?
Definition
HTN
Ms atrophy
Pretransplant changes
Suboptimal nutrition
deconditioning
Term
PT evaluation is initiated in ICU how soon after sx?
Definition
12-24 hours
Term
Why is protective isolation done after sx?
Definition
Immunosuppression (see these pts first and do not see them if you are sick)
Term
__ pts are initially intubated and mechanically ventilated. They are on multiple medications, multiple IV lines, chest drainage tubes, endocardial pacemaker wires, urinary catheter, and multiple monitoring lines
Definition
Transplant
Term
What are the PT goals in the post operative inpatient phase?
Definition
Improve function and QOL
Specifically functional abilities in self-care and mobility
Term
In ICU after a heart transplant, name 5 things the PT will examine and focus on
Definition
1. Impaired gas exchange
2. Airway clearance
3. Effects of prolonged static positioning during sx
4. Pain
5. Mobility restrictions
Term
In ICU, after a heart transplantation, how is exercise started?
Definition
Supine, then progress to sit-to-stand
Term
What are 2 major education topics the PT will focus on in ICU setting after heart transplant?
Definition
Safety
Correct performance of exercise
Term
Name 3 possible complications in acute phase after heart transplant.
Definition
1. Bacterial infections
2. Nonspecific graft failure
3. Acute rejection
Term
Lung transplantation typically begins 1st day post-op in ICU. PT will look at cardiopulmonary conditioning, and the problems and goals are similar to the heart transplant ones. PT will make sure to pay attention to changes in the lungs caused by what?
Definition
Pulmonary denervation
Term
Name 4 main focuses of the PT on lung transplant in ICU setting
Definition
Pulmonary hygiene
Optimal positioning
Mobilization
Cough effort
Term
After the pt leaves ICU, that is the PT focusing on?
Definition
-Ventilation and Airway clearance for optimal oxygen transport
-Thoracic mobility
-Breathing exercises
Term
Name the discharge goals after a lung transplantation
Definition
Independence in self-care, secretion clearance, increased thoracic mobility, general strength and endurance, ability to participate in HEP
Term
Name some possible complications following lung transplantation.
Definition
-Infection
-Ischemia-reperfusion injury
-Acute graft failure
-Acute rejection
-Symptomatically, infection and acute rejection are noted to have low-grade fever and leukocytosis
-
Term
This phase begins following hospital discharge and continues until discharge from formal rehab program - typically 6 weeks
Definition
Post-op outpt phase
Term
What are the discharge goals from the post-operative outpatient phase?
Definition
-Functional capacity improved to allow return to normal activities (work/school)
-Achieve goals - competent with self-monitoring and independent in HEP
Term
What test is typically used to determine the exercise prescription for the post-operative outpatient phase?
Definition
6 minute walk test
Term
What are 7 S&S of Acute Rejection
Definition
Low grade fever
Increase in resting BP
Hypotension w/activity
Myalgia
Fatigue
Decreased exercise tolerance
Ventricular dysrhythmias
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