[Peroperative management of the orthotopic implant of a Jarvik-7 total cardiac prosthesis].
A 31 years old woman with a terminal phase dilated cardiomyopathy and a ventricular ejection fraction of 0.12 was admitted to our hospital to be included in the cardiac transplantation program. When entering the hospital her condition worsened and she suffered an electromechanical dissociation that needed cardiopulmonary resuscitation. Few hours later, energetic medical treatment could not improve her haemodynamic situation. Having no adequate organ available for emergency transplantation, a total orthotopic prosthesis (Jarvik-7-70) implantation was decided. Anesthesia was maintained with fentanyl (50 micrograms/kg), droperidol (0.23 mg/kg) and diazepam (0.25 mg/kg). There were no incidents during or after extracorporeal circulation bypass; despite the use of furosemide (100 mg) and mannitol (1 g/kg) diuresis was less than 40 ml/h. After by-pass, pulmonary hypertension was observed and treated with sodium nitroprusside (1 microgram/kg/min) and isoproterenol (5 micrograms/kg/min), as well as increasing the right ventricle working pressure of the device from 40 to 70 mmHg, obtaining haemodynamic stabilization and good tissular perfusion. After operation, the patient arrived to the Recovery Unit in a steady situation, with a cardiac index of 2.87 l/min/m2 and a diuresis of 150 ml/h. Some other aspects of the anaesthetic management are also discussed in this paper.
Fraile
J R
JR
Martínez
M V
MV
Escarpa
A
A
del Caño
M C
MC
Planas
A
A
Aragón
A
A
Gómez-Arnau
J
J
Arcas
M
M
Rodríguez
E
E
D000328:Adult; D000758:Anesthesia; D002311:Cardiomyopathy, Dilated / Q000601:surgery*; D005260:Female; D006339:Heart Rate; D006354:Heart, Artificial; D006801:Humans; D007430:Intraoperative Care; D013030:Spain
Manejo peroperatorio del implante ortotópico de una prótesis cardíaca total modelo Jarvik-7.