Answered>Order 17875

PREOPERATIVE DIAGNOSIS: Ischemic cardiomyopathy.

POSTOPERATIVE DIAGNOSIS: Ischemic cardiomyopathy.

PROCEDURE PERFORMED:

1. Orthotopic heart transplantation.

2. Removal of pacemaker.

3. Cutdown of radial artery with arterial line insertion.

4. Swan Ganz catheter insertion.

ANESTHESIA TYPE: General.

INDICATIONS:

The patient is a 24-year-old with a history of ischemic cardiomyopathy, listed as 1A for cardiac transplantation a heart became available for the patient. The risks and possible complications

were discussed with the patient and he agreed to undergo the procedure.

PROCEDURE: The full procedure will be dictated by primary surgeon. Upon arrival with the donor heart, the patient was already on cardiopulmonary bypass and his heart had been explanted. The donor heart was removed from the cooler and was inspected and found to be intact. The left atrium was first anastomosed. This was followed by the IVC and SVC. Next, the pulmonary artery was re-anastomosed with a running 4-0 suture. The aorta was then anastomosed. The Swan Ganz catheter was directly placed into the pulmonary artery prior to the pulmonary artery anastomosis. The patient was then rewarmed. The cross clamp was removed and the heart began to beat in sinus rhythm. Echocardiogram revealed good cardiac function. At this time hemostasis was ensured. Pacer wires were placed. Bilateral pleural spaces were entered and a large right pleural effusion was drained. Three chest tubes were then inserted with one in each pleural space and a third in the mediastinum. Again hemostasis was checked and ensured. At this time sternal wires were then placed in a figure-of-eight fashion. The soft tissue was then approximated in layers. The skin was then closed with a running 3-0 Vicryl suture. The patient’s pacemaker was removed from the left chest pocket. Hemostasis was achieved in a pocket. This wound was then closed in multiple layers as well. The chest tubes were then watched for approximately 30 minutes in the operating room. There was no evidence of any significant bleeding. At this time the patient was then transferred to the cardiovascular intensive care unit in fair condition.