Kalp Nakli ve Hemşirelik Bakımı
Özet
Kalp nakli sonrası hasta yönetimi zorlu bir süreçtir. Kalp nakli sonrası hastalarda, enfeksiyon ve sistemik inflamatuar yanıtların yanı sıra, kendine özgü klinik komplikasyonlar da (immunosüpresif tedavi ve kardiyak allotransplant reddi ile ilişkili) görülebilir. Morbidite ve mortaliteye sebep olabilecek, nakil ile ilişkili komplikasyonlar için yüksek dikkat, erken tanı ve uygun müdahalede bulunulması gerekmektedir. Ameliyat sonrası erken dönemde, genellikle aktif hemodinamik yönetim gerektirir ve bu dönem, yeni kalp normal kardiyak fonksiyonunu geri kazandıkça hemodinamik stabilitenin sürdürülmesine odaklanılmalıdır.
Patient management after heart transplantation is a challenging process. In addition to infection and systemic inflammatory responses, unique clinical complications (related to immunosuppressive therapy and cardiac allotransplant rejection) may also occur in patients after heart transplantation. Transplant-related complications, which can cause morbidity and mortality, require high vigilance, early diagnosis and appropriate intervention. The early postoperative period often requires active hemodynamic management and should focus on maintaining hemodynamic stability as the new heart regains normal cardiac function.
Referanslar
Velleca A, Shullo MA, Dhital K, et al. The International Society for Heart and Lung Transplantation (ISHLT) guidelines for the care of heart transplant recipients. J Heart Lung Transplant. 2023 May;42(5):e1-e141. doi: 10.1016/j.healun.2022.10.015.
Ahmed T, Jain A. Heart Transplantation. 2023 May 22. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 32491503.
Potena L, Zuckermann A, Barberini F, et al. A. Complications of Cardiac Transplantation. Curr Cardiol Rep. 2018 Jul 10;20(9):73. doi: 10.1007/s11886-018-1018-3.
Fraund, S, Pethig K, Franke U. Ten year survival after heart transplantation: palliative procedure or successful long term treatment?. Heart 82 (1):47–51, 1999.
Crawford TC, Leary PJ, Fraser CD, et al. Impact of the new pulmonary hypertension definition on heart transplant outcomes. Chest 2020;157:151-61.
Yost G, Gregory M, Bhat G. Short-form nutrition assessment in patients with advanced heart failure evaluated for ventricular assist device placement or cardiac transplantation. Nutr Clin Pract 2014;29:686-91.
Condon DF, Nickel NP, Anderson R, et al. The 6th world symposium on pulmonary hypertension: what’s old is new. F1000Research 2019;8:888.
Tsukashita M, Takayama H, Takeda K, et al. Effect of pulmonary vascular resistance before left ventricular assist device implantation on short- and long-term post-transplant survival. J Thorac Cardiovasc Surg 2015;150:1352-61. e2.
Tedford RJ, Beaty CA, Mathai SC, et al. Prognostic value of the pretransplant diastolic pulmonary artery pressure−to−pulmonary capillary wedge pressure gradient in cardiac transplant recipients with pulmonary hypertension. J Heart Lung Transplant 2014;33:289-97.
Mehra MR, Canter CE, Hannan MM, et al. The 2016 International Society for Heart Lung Transplantation listing criteria for heart transplantation: a 10-year update. J Heart Lung Transplant 2016;35:1-23.
Koulova A, Gass AL, Patibandla S, et al. Management of pulmonary hypertension from left heart disease in candidates for orthotopic heart transplantation. J Thorac Dis 2017;9:2640-9.
den Uil CA, Akin S, Jewbali LS, et al. Short-term mechanical circulatory support as a bridge to durable left ventricular assist device implantation in refractory cardiogenic shock: a systematic review and meta-analysis. Eur J Cardiothorac Surg 2017;52:14-25.
Potapov EV, Antonides C, Crespo-Leiro MG, et al. 2019 EACTS expert consensus on long-term mechanical circulatory support. Eur J Cardiothorac Surg 2019;56:230-70.
Rihal CS, Naidu SS, Givertz MM, et al. 2015 SCAI/ACC/HFSA/STS clinical expert consensus statement on the use of percutaneous mechanical circulatory support devices in cardiovascular care: endorsed by the American Heart Assocation, the Cardiological Society of India, and Sociedad Latino Americana de Cardiologia Intervencion; Affirmation of Value by the Canadian Association of Interventional Cardiology-Association Canadienne de Cardiologie d’intervention. J Am Coll Cardiol 2015;65:e7-e26.
Sanchez-Enrique C, Jorde UP, Gonzalez-Costello J. Heart transplant and mechanical circulatory support in patients with advanced heart failure. Rev Espa~nola Cardiol (English Edition) 2017;70:371-81.
Bozzetti G, Ranucci M, Grillone G. Concomitant pulmonary hypertension and vasoplegia syndrome after heart transplant: a challenging picture. J Cardiothorac Vasc Anesth 2008;22:868-71.
Truby LK, Takeda K, Farr M, et al. Incidence and impact of on-cardiopulmonary bypass vasoplegia during heart transplantation. ASAIO J 2018;64:43-51.
Lee JK, Ing C. Prothrombin complex concentrate and methylene blue for treatment of coagulopathy and vasoplegia in a pediatric heart transplant patient. A Case Reports 2016;6:127-9.
Levy B, Fritz C, Tahon E, et al. Vasoplegia treatments: the past, the present, and the future. Critical Care 2018;22:52.
Sacks LD, Hollander SA, Zhang Y, et al. Vasoplegia after pediatric cardiac transplantation in patients supported with a continuous flow ventricular assist device. J Thorac Cardiovasc Surg. 2019 Jun;157(6):2433-2440. doi: 10.1016/j.jtcvs.2019.01.100.
Rabin J, Kaczorowski DJ. Perioperative Management of the Cardiac Transplant Recipient. Crit Care Clin 2019;35:45-60.
Raza FS, Lee AY, Jamil AK, et al. Relation of vasoplegia in the absence of primary graft dysfunction to mortality following cardiac transplantation. Am J Cardiol 2018;122:1902-8.
Zundel MT, Boettcher BT, Feih JT, et al. Use of oral droxidopa to improve arterial pressure and reduce vasoactive drug requirements during persistent vasoplegic syndrome after cardiac transplantation. J Cardiothorac Vasc Anesth 2016;30:1624-6.
Ardehali A, Hughes K, Sadeghi A, et al. Inhaled nitric oxide for pulmonary hypertension after heart transplantation. Transplantation 2001;72:638-41.
Auler Junior JO, Carmona MJ, Bocchi EA, et al. Low doses of inhaled nitric oxide in heart transplant recipients. J Heart Lung Transplant 1996;15:443-50.
De Wet CJ, Affleck DG, Jacobsohn E, et al. Inhaled prostacyclin is safe, effective, and affordable in patients with pulmonary hypertension, right heart dysfunction, and refractory hypoxemia after cardiothoracic surgery. J Thorac Cardiovasc Surg 2004;127:1058-67.
Khan TA, Schnickel G, Ross D, et al. A prospective, randomized, crossover pilot study of inhaled nitric oxide versus inhaled prostacyclin in heart transplant and lung transplant recipients. J Thorac Cardiovasc Surg 2009;138:1417-24.
Kieler-Jensen N, Lundin S, Ricksten SE. Vasodilator therapy after heart transplantation: effects of inhaled nitric oxide and intravenous prostacyclin, prostaglandin E1, and sodium nitroprusside. J Heart Lung Transplant 1995;14:436-43.
McGinn K, Reichert M. A comparison of inhaled nitric oxide versus inhaled epoprostenol for acute pulmonary hypertension following cardiac surgery. Ann Pharmacother 2016;50:22-6.
Rao V, Ghadimi K, Keeyapaj W, et al. Inhaled nitric oxide (iNO) and inhaled epoprostenol (iPGI 2) use in cardiothoracic surgical patients: is there sufficient evidence for evidencebased recommendations? J Cardiothorac Vasc Anesth 2018;32:1452- 7.
Torbic H, Szumita PM, Anger KE, et al. Inhaled epoprostenol vs inhaled nitric oxide for refractory hypoxemia in critically ill patients. J Crit Care 2013;28:844-8.
Cantillon DJ, Tarakji KG, Hu T, et al. Long-term outcomes and clinical predictors for pacemaker-requiring bradyarrhythmias after cardiac transplantation: analysis of the UNOS/OPTN cardiac transplant database. Heart Rhythm 2010;7:1567-71.
Wellmann P, Herrmann FEM, Hagl C, et al. Single Center Study of 1,179 Heart Transplant Patients-Factors Affecting Pacemaker Implantation: Pacemaker implantation after heart transplantation. Pacing Clin Electrophysiol 2017;40:247-54.
Brignole M, Auricchio A, Baron-Esquivias G, et al. 2013 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy: the Task Force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association (EHRA). Eur Heart J 2013;34:2281-329.
Kusumoto FM, Schoenfeld MH, Barrett C, et al. 2018 ACC/AHA/ HRS guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol 2019;74:e51-e156.
Ahmari S, Bunch T, Chandra A, et al. Prevalence, pathophysiology, and clinical significance of post-heart transplant atrial fibrillation and atrial flutter. J Heart Lung Transplant 2006;25:53-60.
Rivinius R, Helmschrott M, Ruhparwar A, et al. Long-term use of amiodarone before heart transplantation significantly reduces early post-transplant atrial fibrillation and is not associated with increased mortality after heart transplantation. Drug Des Devel Ther. 2016 Feb 16;10:677-86. doi: 10.2147/DDDT.S96126.
Nof E, Stevenson WG, Epstein LM, et al. Catheter ablation of atrial arrhythmias after cardiac transplantation: findings at EP study utility of 3-D mapping and outcomes: catheter ablation of atrial arrhythmias. J Cardiovasc Electrophysiol 2013;24:498-502.
Flyer JN, Zuckerman WA, Richmond ME, et al. Prospective study of adenosine on atrioventricular nodal conduction in pediatric and young adult patients after heart transplantation. Circulation 2017;135:2485-93.
Blaha J, Mraz M, Kopecky P, et al. Perioperative tight glucose control reduces postoperative adverse events in nondiabetic cardiac surgery patients. J Clin Endocrinol Metabol 2015;100:3081- 9. 40.
Jacobi J, Bircher N, Krinsley J, et al. Guidelines for the use of an insulin infusion for the management of hyperglycemia in critically ill patients. Crit Care Med 2012;40:3251-76.
Rodbard HW, Jellinger PS, Davidson JA, et al. Statement by an American Association of Clinical Endocrinologists/American College of Endocrinology consensus panel on type 2 diabetes mellitus: an algorithm for glycemic control. Endocr Pract 2009;15:540-59.
Turan S, Ordueri NE, Uysal BB. İnsülin direncinin lenfosit morfolojisi üzerinden değerlendirilmesi. 2022.Uzmanlık Tezi, Biruni Üniversitesi, İstanbul.
Schenk S, Schoenhals GJ, de Souza G, et al. A high confidence, manually validated human blood plasma protein reference set. BMC medical genomics, 2008;1, 1-28.
Gianotti L, Sandini M, Romagnoli S, et al. Enhanced recovery programs in gastrointestinal surgery: Actions to promote optimal perioperative nutritional and metabolic care. Clinical Nutrition, 2020;39(7), 2014-2024.
Arslan Ü. Kalp ve damar cerrahisinde enfeksiyonlar. 2023. Livre deLyon, Fransa.
Parizh D, Ascher E, Raza Rizvi SA, et al. Quality improvement initiative: preventative surgical site infection protocol in vascular surgery. Vascular. 2018;26(1):47-53.
Wolfe CR, Mooney ML. Management of infections of devices: catheter-related infections, pretransplant VAD infections, infections of ECMO devices. Infectious Diseases in Solid-Organ Transplant Recipients: A practical approach, 2019;279-289.
Velleca A,et al. The International Society for Heart and Lung Transplantation (ISHLT) guidelines for the care of heart transplant recipients. J Heart Lung Transplant. 2023 May;42(5):e1-e141. doi: 10.1016/j.healun.2022.10.015.
Carney KC, Bronzell-Wynder T, Gronek K. Lung transplant for the critical care nurse. Critical Care Nursing Clinics, 2019;31(3), 285-302.
Abdala E, Miller R, Pasqualotto AC, et al. Endemic fungal infection recommendations for solid-organ transplant recipients and donors. Transplantation 2018;102:S52-9.
Robert-Gangneux F, Meroni V, Dupont D, et al. Toxoplasmosis in transplant recipients, Europe, 2010−2014. Emerg Infect Dis 2018;24:1497-504.
Silveira FP, Husain S. Fungal infections in solid organ transplantation. Med Mycol 2007;45:305-20.
Yağdı T, Engin Ç, Özbaran M. Türkiye'de kalp transplantasyonunun güncel durumu. Türk Kardiyoloji Derneği Arşivi,2014; 42(8).
Phan K, Luc JGY, Xu J, et al. Utilization and Outcomes of Temporary Mechanical Circulatory Support for Graft Dysfunction After Heart Transplantation. ASAIO J. 2017 Nov/Dec;63(6):695-703.
Demiralp G, Arrigo RT, Cassara C, et al. Heart Transplantation-Postoperative Considerations. Crit Care Clin. 2024 Jan;40(1):137-157. doi: 10.1016/j.ccc.2023.05.004.
Kolsrud O, Karason K, Holmberg E, et al. Renal function and outcome after heart transplantation. The Journal of Thoracic and Cardiovascular Surgery, 2018;155(4), 1593-1604.
Bessede T, Hammoudi Y, Bedretdinova D, et al. Preoperative risk factors associated with urinary complications after kidney transplantation. In Transplantation proceedings, 2017;49,9,2018-2024
De Gasperi A, Narcisi S, Mazza E, et al. Perioperative fluid management in kidney transplantation: is volume overload still mandatory for graft function?. In Transplantation proceedings 2006;38,3,807-809
Hsu RB, Chang CI, Lin FY, et al. (2008). Heart transplantation in patients with liver cirrhosis. European journal of cardio-thoracic surgery, 2008;34(2), 307-312.
Wiegan, J, Berg T. The etiology, diagnosis and prevention of liver cirrhosis: part 1 of a series on liver cirrhosis. Deutsches Ärzteblatt International, 2013;110(6), 85.
Klotz S, Vestring T, Rötker, et al.Diagnosis and treatment of nonocclusive mesenteric ischemia after open heart surgery. The Annals of thoracic surgery, 2001; 72(5), 1583-1586.
Watson CJE, Jamieson NV, Johnston,PS, et al. Early abdominal complications following heart and heart–lung transplantation. Journal of British Surgery, 1991;78(6), 699-704.
Kainuma A, Ning Y, Kurlansky PA, et al. Deep vein thrombosis and pulmonary embolism after heart transplantation. Clinical Transplantation, 2022;36(7), e14705.
Carro A, Panisello JM, Coats AJS. Nutritional status in advanced heart failure and heart transplant patients. Rev Esp Cardiol, 2017;70(8), 626-8.
Kourek C, Karatzanos E, Nanas S, et al. Exercise training in heart transplantation. World Journal of Transplantation, 202;11(11), 466.
Saglam Aksut R, Yavuz B, Aksut M, Gunay D, Kirali MK. Symptoms Experienced at Home and Self-Care Requisites of Patients After Heart Transplantation: A Retrospective Study. Home Health Care Management & Practice. 2024;36(1):54-60. doi:10.1177/10848223231165754
Grady KL, Wang E, Higgins R, Heroux A, Rybarczyk B, Young JB, Pelegrin D, Czerr J, Kobashigawa J, Chait J, Naftel DC, White Williams C, Myers S, Kirklin JK. Symptom frequency and distress from 5 to 10 years after heart transplantation. J Heart Lung Transplant. 2009 Aug;28(8):759-68. doi: 10.1016/j.healun.2009.04.020.
Dalvindt M, Nozohoor S, Kisch A, Lennerling A, Forsberg A. Symptom Occurrence and Distress after Heart Transplantation-A Nationwide Cross-Sectional Cohort Study. Int J Environ Res Public Health. 2020 Nov 1;17(21):8052. doi: 10.3390/ijerph17218052.
Selbst MK, Ahrens WA, Robert ME, Friedman A, Proctor DD, Jain D. Spectrum of histologic changes in colonic biopsies in patients treated with mycophenolate mofetil. Mod Pathol. 2009 Jun;22(6):737-43. doi: 10.1038/modpathol.2009.44.
Baur B, Oroszlan M, Hess O, Carrel T, Mohacsi P. Efficacy and safety of sirolimus and everolimus in heart transplant patients: a retrospective analysis. Transplant Proc. 2011 Jun;43(5):1853-61. doi: 10.1016/j.transproceed.2011.01.174. PMID: 21693289.
Selbst MK, Ahrens WA, Robert ME, Friedman A, Proctor DD, Jain D. Spectrum of histologic changes in colonic biopsies in patients treated with mycophenolate mofetil. Mod Pathol. 2009 Jun;22(6):737-43. doi: 10.1038/modpathol.2009.44.
Klewitz F, Nöhre M, Bauer-Hohmann M, Tegtbur U, Schiffer L, Pape L, Schiffer M, de Zwaan M. Information Needs of Patients About Immunosuppressive Medication in a German Kidney Transplant Sample: Prevalence and Correlates. Front Psychiatry. 2019 Jun 28;10:444. doi: 10.3389/fpsyt.2019.00444.
Stenman C, Gillstedt M, Barck L, Gonzalez H, Halldin C, Wallinder A, Paoli J, Osmancevic A, Claeson M. Sun protection behaviour in organ transplant recipients and non-transplant patients attending a dermatology outpatient clinic in Sweden: A questionnaire survey. Photodermatol Photoimmunol Photomed. 2022 Mar;38(2):132-140. doi: 10.1111/phpp.12726.
