Cardiopulmonary Transplantation and

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Cardiopulmonary
Transplantation and
Mechanical Circulatory
Support
ii

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Cardiopulmonary
Transplantation
and Mechanical
Circulatory
Support
edited by
Maziar Khorsandi, Steven Tsui,
John Dark, Alan J. Kirk,
Matthew Hartwig,
Mani A. Daneshmand, and
Carmelo Milano
illustrated by
Jay LeVasseur
iv

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To my parents Shahin and Ali Khorsandi, MD and to the memory
of Edward “Ted” Brackenbury, FRCS
vi
 vii

Foreword
When people speak of vitality, it is often with reference to cardiorespira-
tory function. Indeed, throughout human history people have intuitively
associated heart and lung function with one’s life, virtue, and soul. Thus,
when heart and lung transplantation emerged in the 1960s, it captured the
world’s attention far more than kidney or liver transplantation. After all, we
associate ourselves with every heartbeat, every breath; not so much with
urine and bile. It was as though successful replacement of the heart and
lungs forced us to consider our humanity, and thus seemed more miracu-
lous than technical.
The past 60 years have led the elements of pulse and breath to be char-
acterized so well that they are now regularly exchangeable. The world is
approaching its 100,000th cardiopulmonary transplantation, and mechan-
ical support devices are rapidly becoming commonplace. With such preva-
lence, one would think that cardiopulmonary replacement might have lost
its lustre. Yet every time I think about a heart or lung transplant, or a left
ventricular assist device deployment, it still seems like a miracle to me—​not
because the mechanics and biology are mysterious, but rather because they
are now so well defined. To be sure, it is immensely technical, and it is the
enormity of what we now know about this practice that makes it so im-
pressive. Assembling that knowledge into a usable format is increasingly
important and challenging.
In saying that transplantation is technical, it is not to imply that it is amen-
able to rote education. There is really no transplant procedure that is
exactly like another. Each case has its unique physiology, immunology, and
histocompatibility, the latter of which literally defines individuality. There
are so many reasons that this should not work, yet it does, almost routinely.
I believe this is a tribute to the dedicated people who try to make sense
of each case and derive and curate generalizable insights. Cardiopulmonary
Transplantation and Mechanical Circulatory Support is a collection of those
insights, to be used in the adept navigation of each improbable success.
This is a concise resource to help practitioners quickly refresh the relevant
information needed to recognize problems and deal with them. This is not
a comprehensive treatise, as each chapter could warrant a book in and unto
itself. Rather, this is a means of practical guidance, placing clinical challenges
into the broad contexts of cardiopulmonary physiology and transplant im-
munology. It will be particularly useful to trainees, and to nurses, advanced
practice providers, intensivists, and hospitalists caring for transplant patients
and needing quick reference. This is a resource to provide order to the rap-
idly accumulating practical information needed to routinely transform lives,
one miracle at a time.
Allan D. Kirk, MD, PhD, FACS
David C. Sabiston, Jr. Distinguished Professor of Surgery,
Immunology and Pediatrics
Chairman of the Department of Surgery
Duke University Medical Center
Durham, NC, USA
vii
 ix

Foreword
Cardiopulmonary Transplantation and Mechanical Circulatory Support
will serve as a valuable resource for residents, fellows, and advanced care
practitioners. Thirty-​eight chapters cover a variety of important topics, rep-
resenting several years of effort by an international slate of authors and
editors. While much of what we do in surgery for advanced heart and lung
failure is evidence based, a substantial amount of it is also based on per-
sonal opinion, consensus, and institutional preference. What is presented
here falls into the latter category. However, trainees require a foundational
understanding of key concepts and techniques to begin their education in
the field. This handbook is a practical guide and an excellent starting point
for individuals learning to practice in this field. By no means is this intended
as a definitive treatment on this topic but rather to lay the ground work for
lifelong learning. Managing Editor Maz Khorsandi will be updating this hand-
book to ensure content remains current.
Those who possess a highly-​developed awareness of this field and know-
ledge of related literature may take issue with some of the points made
in the text. However, authors have attempted to simplify the concepts in
order to make them more approachable to the reader. The best use of
this handbook would be for study preparation by trainees with directed
follow-​up discussion with their attending providers, as well as focused lit-
erature searches to enhance and refine their depth of understanding. As
these fields continue in their inevitable evolution, the stewardship of con-
tinued learning will require humility and receptiveness to new concepts and
ideas that challenge existing notions, concepts, or dogma. This handbook is
a starting point that is very readable, approachable, and useful. As such, it
should inspire readers to engage in this complex and rapidly-​evolving field
and serve as a catalyst for advanced learning.
Michael S. Mulligan, MD
Professor and Chief, Division of Cardiothoracic Surgery
Endowed Professor in Lung Transplant Research
Director, Lung Transplant Program
University of Washington
x
 xi

Preface
As I approached the final stretch of my specialty training in cardiothoracic
surgery, I felt that there was a paucity of a quick reference manual for my
subspecialty field of interest, cardiopulmonary transplantation and mech-
anical circulatory support. Most reference guides were large, cumbersome,
and already outdated by the time they were published. Henceforth, I felt
the need to embark on this handbook project. I was further encouraged
and supported by my mentors Dr Carmelo Milano, MD, Duke University
Medical Center, USA, and Mr Edward ‘Ted’ Brackenbury, FRCS C/​Th,
Royal Infirmary of Edinburgh, UK. Furthermore, Duke University Heart
Center generously supported the project financially.
Cardiopulmonary Transplantation and Mechanical Circulatory Support is a
comprehensive yet succinct and readily available pocket guide of the most
up-​to-​date developments in the field of heart and lung transplantation and
mechanical circulatory support. The most prominent and globally respected
experts in Europe and North America were selected as editors and authors
for this handbook and the content, for the most part, reflects their personal
experience, hints, and tips for practitioners on the front line. The handbook
is accompanied by informative text and high-​resolution practical illustrations
making it relevant to all tiers of healthcare professionals such as nurses,
advanced care practitioners, surgical, medical, and critical care residents
and fellows, as well as junior attending/​consultant physicians and surgeons
looking after such critically ill patients. This handbook will be readily avail-
able both as a hard copy and online. I strive to continuously update it with
the most recent evidence-​based practice.
Maziar Khorsandi, FRCS C/​Th
Assistant Professor of Surgery
Attending Cardiothoracic Surgeon
Division of Cardiothoracic Surgery
University of Washington Medical Center
Seattle, WA, USA
xii
 xiii

Acknowledgements
We would like to gratefully acknowledge the generous donation by Duke
University Heart Center in funding the illustrations for this handbook.
xvi
 xv

Contents
Contributors xix
Abbreviations xxvii

Section 1 Heart failure

1 Medical and minimally invasive aspects of heart
failure management 3
Marc D. Samsky and Joseph G. Rogers

2 Myocarditis: diagnosis and treatment 15

Stuart D. Russell

3 Cardiac amyloidosis and other restrictive

myopathies: diagnosis and treatment 27
Rahul Loungani and Chetan Patel

Section 2 Mechanical circulatory support

4 Indications for ventricular assist devices 41
Antonios Kourliouros

5 Surgical techniques for left ventricular assist device

implantation and associated procedures 49
Igor Gosev and Scott Silvestry

6 Clinical trials with durable left ventricular

assist devices 61
Yuting P. Chiang and Mani A. Daneshmand

7 Diagnosis and management of ventricular assist

device complications 69
Maziar Khorsandi, Philip Curry, Sukumaran Nair, and
Nawwar Al-​Attar

8 Extracorporeal membrane oxygenation 79

Jeffrey Javidfar, Maziar Khorsandi, and Mani A. Daneshmand

9 Percutaneous mechanical circulatory support 97

Dominick Megna Jr, Maziar Khorsandi, and Danny Ramzy
 xvi Contents

109 10 The total artificial heart

Dominick Megna Jr and Francisco Arabia

117 11 Post-​cardiac surgery cardiogenic shock

Maziar Khorsandi, Philip Curry, Nawwar Al-​Attar, and
Sukumaran Nair

Section 3 Heart transplantation

12 Patient selection criteria and bridging
131 support for cardiac transplantation
Julie Doberne, Benjamin Bryner, and Chetan Patel

139 13 Cardiac donor selection and management

Ahmed S. Al-​Adhami, Hari Doshi, Nawwar Al-​Attar, and Philip Curry

14 Extended criteria heart donors and

157 perfusion storage
Yaron Barac, Anthony Castleberry, Jacob Schroder, and
Sebastian V. Rojas

15 Donor heart procurement: donation after

brain death and donation after circulatory
171 determined death
Simon Messer, Stephen Large, Marius Berman, and Steven Tsui

185 16 Technical aspects of heart transplantation

Yaron Barac, Christopher White, and Jacob Schroder

17 Critical care management and primary

195 graft dysfunction following cardiac transplantation
Sanjeet A. Singh, Jonathan R. Dalzell, Sukumaran Nair, and
Andrew Sinclair

18 Assessment and management of chronic

209 complications following heart transplantation
Anna K. Barton, Alison I. Smyth, Alan J. Kirk, and Jonathan R. Dalzell

19 Bedside care and rehabilitation with

mechanical circulatory support and
225 thoracic transplantation
Desiree Bonadonna, Lynn McGugan, and Evelyn Watson
 Contents xvii

20 Management of rejection following cardiac

transplantation 233
Sounok Sen and Adam D. DeVore

21 Antimicrobial prophylaxis and treatment of

infection after cardiac transplantation 247
Sana Arif, Sylvia Costa, and Barbara D. Alexander

Section 4 Heart failure in paediatric patients

22.1 Heart transplant for paediatric patients 267
Mohamed Nassar and Asif Hasan

22.2 Paediatric extracorporeal membrane oxygenation 275

Louise Kenny, Ed Peng, and Asif Hasan

22.3 Paediatric heart transplant: specific considerations 287

Ed Peng and Asif Hasan

Section 5 Special considerations in heart

transplantation
23 Adult patients with congenital heart disease 303
Louise Kenny and Asif Hasan

Section 6 Lung transplantation

24 Patient selection criteria and bridging support for
lung transplantation 319
Basil Nasir and John M. Reynolds

25 Lung donor selection and management 337

Stephen C. Clark

26 Lung procurement following donation after brain

death and donation after circulatory death 347
Julie Doberne, Jacob Klapper, and Matthew Hartwig

27 Ex vivo lung perfusion 355

Anders Andreasson, Karen Booth, John Dark, and Abbas Ardehali
xviii Contents

371 28 Technical aspects of lung transplantation

Basil Nasir, Pedro Catarino, and John Haney

29 Critical care management and primary

383 graft dysfunction following lung transplantation
Michael Mulvihill, Nathan Waldron, and Matthew Hartwig

30 Management of rejection following lung

389 transplantation
Lorenzo Zaffiri and Arun Nair

399 31 Late complications following lung transplantation

Yejide Odedina, Jagan Murugachandran, and Jasvir Parmar

32 Antimicrobial prophylaxis and treatment

411 after lung transplantation
Karen Booth and Julie R. Samuel

Section 7 Combined transplantation

423 33 Combined heart–​lung transplantation
Jason Ali, Jasvir Parmar, and Steven Tsui

439 34 Combined thoracoabdominal organ transplantation

Yaron Barac, Jigesh A. Shah, Jacob Schroder, and Andrew S. Barbas

Section 8 Anaesthetic considerations

35 Anaesthetic issues related to
extracorporeal membrane oxygenation
449 and ventricular assist device procedures
Michael W. Manning and Kamrouz Ghadimi

459 36 Anaesthetic issues related to heart transplantation

Philip McCall, Alina Nicoara, and Andrew Sinclair

469 37 Anaesthetic issues related to lung transplantation

Brandi Bottiger, Nazish Hashmi, and Mihai Podgoreanu

Index 481

Contributors
Ahmed S. Al-​Adhami,
FRCS C/​Th
Specialty Registrar
Department of Cardiothoracic
Surgery
Golden Jubilee National Hospital
Glasgow, UK
Chapter 13
Nawwar Al-​Attar, FRCS
C/​Th, PhD
Director of Heart Transplantation
and Consultant Cardiac and
Transplant Surgeon Department of
Cardiothoracic Surgery
Golden Jubilee National Hospital
Glasgow, UK
Chapters 7,11,13
Barbara D. Alexander, MD
Professor of Medicine and
Pathology
Division of Infectious Diseases
Duke University Medical Center
NC, USA
Chapter 21
Jason Ali, MRCS, PhD
Speciality Registrar in
Cardiothoracic Surgery
Department of Cardiothoracic
Surgery
Royal Papworth Hospital
Cambridge, UK
Chapter 33
Anders Andreasson, FRCS
C/Th, PhD
Speciality Registrar in
Cardiothoracic Surgery
Department of Cardiothoracic
Surgery
Freeman Hospital
Newcastle, UK
Chapter 27
xix
Francisco Arabia, MD
Professor of Surgery
Division Chief of Cardiothoracic
Surgery
University of Arizona College of
Medicine
AZ, USA
Chapter 10
Abbas Ardehali, MD
Director of UCLA Heart and Lung
Transplantation Program
Professor of Surgery and William E
Conner Chair of Cardiopulmonary
Transplantation Division of
Cardiothoracic Surgery
Ronald Reagan UCLA Medical Center
CA, USA
Chapter 27
Sana Arif, MBBS
Assistant Professor of Medicine
Division of Infectious Diseases
Duke University Medical Center
NC, USA
Chapter 21
Yaron Barac, MD, PhD
Associate Professor of Surgery and
Cardiovascular Physiology
Director
Heart and Lung Transplant and
Mechanical Circulatory Support
Program
Rabin Medical Center
Sackler Faculty of Medicine
Tel Aviv, Israel
Chapters 14,16,34
Andrew S. Barbas, MD
Assistant Professor of Surgery
Division of Abdominal Transplant
Surgery
Duke University Medical Center
NC, USA
Chapter 34
xx Contributors
Anna K. Barton, MSc, MRCP
Clinical Research Fellow and
Honorary Cardiology Registrar
Centre for Cardiovascular Science
The University of Edinburgh
Edinburgh, UK
Chapter 18
Marius Berman, FRCS C/​Th
Consultant Cardiac and Transplant
Surgeon
Department of Cardiothoracic
Surgery
Royal Papworth Hospital
Cambridge, UK
Chapter 15
Desiree Bonadonna, MPS
Director of Extra-​Corporeal Life
Support
Duke University Medical Center
NC, USA
Chapters 8,19
Karen Booth, FRCS C/​Th
Consultant Cardiac and Transplant
Surgeon
Department of Cardiothoracic
Surgery
Freeman Hospital
Newcastle, UK
Chapters 27,32
Brandi Bottiger, MD
Associate Professor of Anesthesia
Division of Cardiothoracic
Anesthesia and Critical Care
Duke University Medical Center
NC, USA
Chapter 37
Benjamin Bryner, MD
Co-​Director of Duke ECMO
Program and Assistant Professor
of Surgery
Division of Cardiothoracic Surgery
Duke University Medical Center
NC, USA
Chapter 12
Anthony Castleberry, MD
Assistant Professor of Surgery
Division of Cardiothoracic Surgery
University of Nebraska Medical
Center
NE, USA
Chapter 14
Pedro Catarino, FRCS C/​Th
Director of Heart and Lung
Transplantation and Mechanical
Circulatory Support and Consultant
Cardiac and Transplant Surgeon
Royal Papworth Hospital
Cambridge, UK
Chapter 28
Yuting P. Chiang, MD
Resident in Cardiothoracic Surgery
Columbia University Medical Center
NY, USA
Chapter 6
Stephen C. Clark, FRCS C/​Th
Director of Heart and Lung
Transplantation and Professor
of Cardiothoracic Surgery and
Cardiopulmonary Transplantation
Department of Cardiothoracic
Surgery
Freeman Hospital and Newcastle
University
Newcastle, UK
Chapter 25
Sylvia Costa, MD
Adjunct Assistant Professor of
Medicine
Division of Infectious Diseases
Duke University Medical Center
NC, USA
Chapter 21
Philip Curry, FRCS C/​Th, PhD
Clinical Director of Cardiothoracic
Surgery and Consultant Cardiac and
Transplant Surgeon
Department of Cardiothoracic
Surgery
Golden Jubilee National Hospital
Glasgow, UK
Chapters 7,11,13

Jonathan R. Dalzell, FRCP
Consultant Heart Failure
Cardiologist
Scottish National Advanced Heart
Failure Services
Golden Jubilee National Hospital
Glasgow, UK
Chapters 17,18
Mani A. Daneshmand, MD
Director of Heart and Lung
Transplantation and MCS Programs
and Associate Professor of Surgery
Division of Cardiothoracic Surgery
Emory University School of
Medicine
GA, USA
Chapter 6
John Dark, FRCS
Professor of Cardiothoracic
Surgery and Cardiopulmonary
Transplantation
Past President of ISHLT
Newcastle University
Newcastle, UK
Chapter 27
Adam D. DeVore, MD
Assistant Professor of Medicine
Division of Cardiology
Duke University Medical Center
NC, USA
Chapter 20
Julie Doberne, MD, PhD
Resident in Cardiothoracic Surgery
Duke University Medical Center
NC, USA
Chapters 12,26
Hari Doshi, FRCS C/​Th
Consultant Cardiac and Transplant
Surgeon
Department of Cardiothoracic
Surgery
Golden Jubilee National Hospital
Glasgow, UK
Chapter 13
Contributors xxi
Kamrouz Ghadimi, MD
Associate Professor of
Anesthesiology
Division of Cardiothoracic
Anesthesia and Critical Care
Duke University Medical Center
NC, USA
Chapter 35
Igor Gosev, MD, PhD
Assistant Professor
Division of Cardiothoracic Surgery
University of Rochester Medical
Center
NY, USA
Chapter 5
John Haney, MD
Surgical Director of Lung
Transplantation and Assistant
Professor of Surgery
Division of Cardiothoracic Surgery
Duke University Medical Center
NC, USA
Chapter 28
Matthew Hartwig, MD
Associate Professor of Surgery
Division of Cardiothoracic Surgery
Duke University Medical Center
NC, USA
Chapters 26,29
Asif Hasan, FRCS C/​Th
Consultant Congenital Cardiac and
Transplant Surgeon
Children’s Heart Unit
Freeman Hospital
Newcastle, UK
Chapters 22.1,22.2,23
Nazish Hashmi, MD
Assistant Professor of Anesthesia
Division of Cardiothoracic
Anesthesia and Critical Care
Duke University Medical Center
NC, USA
Chapter 37
xxii Contributors
Jeffrey Javidfar, MD
Assistant Professor of Surgery and
Assistant Surgical Director of the
Lung Transplantation Program
Division of Cardiothoracic Surgery
Emory University School of Medicine
GA, USA
Chapter 8
Louise Kenny, FRCS C/​Th
Specialist Registrar in Congenital
Cardiac Surgery
Children’s Heart Unit
Freeman Hospital
Newcastle, UK
Chapters 22.2, 23
Maziar Khorsandi, FRCS C/​Th
(Managing editor)
Assistant Professor of Surgery
Division of Cardiothoracic Surgery
University of Washington Medical
Center
WA, USA
Chapters 7,8,9,11
Alan J. Kirk, FRCS
Honorary Professor of Surgery
Consultant Thoracic Surgeon
Golden Jubilee National Hospital
and University of Glasgow
Glasgow, UK
Chapter 18
Jacob Klapper, MD
Assistant Professor of Surgery
Division of Cardiothoracic Surgery
Duke University Medical Center
NC, USA
Chapter 26
Antonios Kourliouros, FRCS
C/​Th, PhD
Consultant Cardiac Surgeon
Oxford Heart Centre
John Radcliffe Hospital
Oxford, UK
Chapter 4
Stephen Large, FRCS C/​Th
Consultant Cardiac and Transplant
Surgeon
Department of Cardiothoracic
Surgery
Royal Papworth Hospital
Cambridge, UK
Chapter 15
Rahul Loungani, MD
Cardiology Fellow
Division of Cardiology
Duke University Medical Center
NC, USA
Chapter 3
Michael W. Manning,
MD, PhD
Associate Professor of Anesthesia
Division of Cardiothoracic
Anesthesia and Critical Care
Duke University Medical Center
NC, USA
Chapter 35
Philip McCall, FRCA
Fellow in Cardiothoracic
Anaesthesia and Critical Care
Golden Jubilee National Hospital
Glasgow, UK
Chapter 36
Lynn McGugan, ACNP
Critical Care Nurse Practitioner
Duke University Medical Center
NC, USA
Chapter 19
Dominick Megna Jr, MD
Assistant Professor of Surgery
Surgical Director of Lung
Transplantation Program
Division of Cardiothoracic Surgery
Cedar Sinai Medical Center
CA, USA
Chapters 9,10
Simon Messer, MRCS, PhD
Registrar in Cardiothoracic Surgery
Department of Cardiothoracic
Surgery
Royal Papworth Hospital
Cambridge, UK
Chapter 15
 Contributors xxiii

Carmelo Milano, MD Alina Nicoara, MD

Professor of Surgery
Chief Section of Adult Cardiac
Surgery
Division of Cardiothoracic Surgery
Duke University Medical Center
NC, USA
Michael Mulvihill, MD
Resident in Cardiothoracic Surgery
Duke University Medical Center
NC, USA
Chapter 29
Jagan Murugachandran, MRCP
Registrar in Internal and Respiratory
Medicine
Specialty Registrar in Respiratory
Critical Care and General Internal
Medicine
Royal Papworth Hospital
Cambridge, UK
Chapter 31
Arun Nair, FRCP
Consultant in Respiratory Medicine
and Lung Transplantation
Department of Respiratory
Medicine and Lung Transplantation
Freeman Hospital
Newcastle, UK
Chapter 30
Sukumaran Nair, FRCS C/​Th
Consultant Cardiac and Transplant
Surgeon
Golden Jubilee National Hospital
Glasgow, UK
Chapters 7,11,17
Basil Nasir, FRCSC
Assistant Professor of Surgery
Division of Thoracic Surgery
Centre Hospitalier de l’Université
de Montréal
Montreal, Canada
Chapters 24,28
Mohamed Nassar, FRCS C/​Th
Consultant Congenital Cardiac and
Transplant Surgeon
Freeman Hospital
Newcastle, UK
Chapter 22.1
Associate Professor of Anesthesia
Division of Cardiothoracic
Anesthesia and Critical Care
Duke University Medical Center
NC, USA
Chapter 36
Yejide Odedina, MRCP
Specialty Registrar in Respiratory
and General Internal Medicine
Department of Respiratory and
Internal Medicine
Royal Papworth Hospital
Cambridge, UK
Chapter 31
Jasvir Parmar, FRCP, PhD
Consultant in Respiratory Medicine
Department of Lung
Transplantation
Royal Papworth Hospital
Cambridge, UK
Chapters 31,33
Chetan Patel, MD
Associate Professor of Medicine
Division of Cardiology
Duke University Medical Center
NC, USA
Chapters 3,12
Ed Peng, FRCS C/​Th
Consultant Cardiac Surgeon, Royal
Hospital
Children Glasgow and Golden
Jubilee National Hospital
Scotland, UK
Chapters 22.2, 22.3
Mihai Podgoreanu, MD
Chief of Division of Cardiothoracic
Anesthesia and Critical Care and
Associate Professor of Anesthesia
Duke University Medical Center
NC, USA
Chapter 37
Danny Ramzy, MD, PhD
Associate Professor of Surgery
Division of Cardiothoracic Surgery
Cedar Sinai Medical Center
CA, USA
Chapter 9
xxiv Contributors
John M. Reynolds, MD
Medical Director of Lung
Transplantation and Associate
Professor of Medicine
Division of Lung Transplantation,
Pulmonary and Critical Care
Duke University Medical Center
NC, USA
Chapter 24
Joseph G. Rogers, MD
Chief Medical Officer and Professor
of Medicine
Division of Cardiology
Duke University Medical Center
NC, USA
Chapter 1
Sebastian V. Rojas, MD
Co-​Director of Cardiac
Transplantation
Department of Cardiothoracic,
Transplantation and Vascular
Surgery
Hannover Medical School
Hannover, Germany
Chapter 14
Stuart D. Russell, MD
Director of Heart Failure and
Professor of Medicine
Division of Cardiology
Duke University Medical Center
NC, USA
Chapter 2
Marc D. Samsky, MD
Cardiology Fellow
Division of Cardiology
Duke University Medical Center
NC, USA
Chapter 1
Julie R. Samuel, FRCPath
Clinical Director of the Department
of Clinical Microbiology and
Consultant Clinical Microbiologist
Freeman Hospital
Newcastle, UK
Chapter 32
Jacob Schroder, MD
Director of Heart Transplantation
Program and Assistant Professor
of Surgery
Division of Cardiothoracic Surgery
Duke University Medical Center
NC, USA
Chapters 14,16,34
Sounok Sen, MD
Cardiology Fellow
Division of Cardiology
Duke University Medical Center
NC, USA
Chapter 20
Jigesh A. Shah, DO
Fellow in Abdominal Organ
Transplantation
Division of Abdominal
Transplantation
Duke University Medical Center
NC, USA
Chapter 34
Scott Silvestry, MD
Surgical Director of Thoracic
Transplantation and Associate
Professor of Surgery
Division of Cardiothoracic Surgery
Florida Hospital Transplant Institute
FL, USA
Chapter 5
Andrew Sinclair, FRCA
Director of Mechanical Circulatory
Support and Consultant in
Anaesthesia and Critical Care
Golden Jubilee National Hospital
Glasgow, UK
Chapters 17,36
Sanjeet A. Singh, MRCS, PhD
Clinical Fellow in Heart
Transplantation
Department of Cardiothoracic
Surgery
Golden Jubilee National Hospital
Glasgow, UK
Chapter 17
 Contributors xxv

Alison I. Smyth, MRCP Evelyn Watson, RN

Clinical Fellow in Heart Failure
Cardiology
Scottish National Advanced Heart
Failure Services
Golden Jubilee National Hospital
Glasgow, UK
Chapter 18
Steven Tsui, FRCS C/​Th
Clinical Director of Transplant
Services and Director of Mechanical
Circulatory Support
Consultant Cardiac and Transplant
Surgeon
Royal Papworth Hospital
Cambridge, UK
Chapters 15,33
Nathan Waldron, MD
Assistant Professor in Anaesthesia
and Critical Care
University of Colorado Health
Memorial Hospital Central
CO, USA
Chapter 29
Specialist Charge Nurse
Regional Transplant Unit
Freeman Hospital and Newcastle
University
Newcastle, UK
Chapter 19
Christopher White,
FRCSC, PhD
Heart Failure Surgeon
Assistant Professor of Surgery
Dalhousie University
New Brunswick Heart Center
NB, Canada
Chapter 16
Lorenzo Zaffiri, MD
Assistant Professor of Medicine
Division of Lung Transplantation,
Pulmonary and Critical Care
Duke University Medical Center
NC, USA
Chapter 30
xxvi
 xxvii

Abbreviations
ABOi AABO incompatible CNS central nervous system
ACC American College of COPD chronic obstructive pulmonary
Cardiology disease
ACE angiotensin-​converting enzyme CPB cardiopulmonary bypass
ACEi angiotensin-​converting enzyme CPR cardiopulmonary resuscitation
inhibitor CPX cardiopulmonary exercise
ACHD adult congenital heart disease CRT cardiac resynchronization
ACT activated clotting time therapy
ADHERE Acute Decompensated Heart CSF cerebrospinal fluid
Failure National Registry CVP central venous pressure
AHA American Heart Association CXR chest X-​ray
AL amyloid light chain DBD donation after brain death
AMR antibody-​mediated rejection DC direct current
Ao aorta DCD donation after
aPTT activated partial circulatory death
thromboplastin time DCM dilated cardiomyopathy
ARB angiotensin II receptor DLCO diffusion capacity of the lung
blocker for carbon monoxide
ARDS acute respiratory distress DPC distal perfusion cannula
syndrome
DSA donor-​specific antibody
ASD atrial septal defect
EACTS European Association for
ATG anti-​thymocyte globulin Cardio-​Thoracic Surgery
ATTR-​CM transthyretin amyloid EBV Epstein–​Barr virus
cardiomyopathy
ECG electrocardiogram
AV atrioventricular
ECLS extracorporeal life support
BAL bronchoalveolar lavage
ECMO extracorporeal membrane
BB beta blocker oxygenation
BiVAD biventricular assist device E-​CPR extracorporeal
BMI body mass index cardiopulmonary resuscitation
BNP B-​type natriuretic peptide EF ejection fraction
BOS bronchiolitis obliterans eGFR estimated glomerular
syndrome filtration rate
BSA body surface area ELSO Extracorporeal Life Support
BSD brainstem death Organization
BTT bridge to transplantation ESR erythrocyte sedimentation rate
CAD coronary artery disease EVLP ex vivo lung perfusion
CAV cardiac allograft vasculopathy FDA Food and Drug Administration
CDAD Clostridium difficile-​associated FEV1 forced expiratory volume in
diarrhoea 1 second
CF cystic fibrosis FiO2 fraction of inspired oxygen
CI cardiac index FVC forced vital capacity
CLAD chronic lung allograft GFR glomerular filtration rate
dysfunction GI gastrointestinal
CMV cytomegalovirus GTN glycerol trinitrate
CNI calcineurin inhibitor HB hepatitis B
xxviii Abbreviations

HBV hepatitis B virus LVEDP left ventricular end-​diastolic

HCV hepatitis C virus pressure
HF heart failure LVEF left ventricular ejection fraction
HFpEF heart failure with preserved LVH left ventricular hypertrophy
ejection fraction MAP mean arterial pressure
HFrEF heart failure with reduced MCS mechanical circulatory support
ejection fraction MELD Model for End-​Stage Liver
HFSS Heart Failure Survival Score Disease
HHV herpesvirus MFI mean fluorescent intensity
HIT heparin-​induced MMF mycophenolate mofetil
thrombocytopenia MR mitral regurgitation
HIV human immunodeficiency virus MRA mineralocorticoid receptor
HKTx heart–​kidney transplantation antagonist
HLA human leucocyte antigen MRI magnetic resonance imaging
HLTx heart–​lung transplantation MRSA methicillin-​resistant
HM HeartMate Staphylococcus aureus
HSV herpes simplex virus mTOR mechanistic target of
rapamycin
hTTR hereditary transthyretin
MV mitral valve
HZ herpes zoster
NAAT nucleic acid amplification
IA invasive aspergillosis testing
IABP intra-​aortic balloon pump/​ NICM non-​ischaemic
counterpulsation cardiomyopathy
ICD implantable cardioverter NO nitric oxide
defibrillator
NODAT new-​onset diabetes after
ICU intensive care unit transplantation
Ig immunoglobulin NRAD neutrophilic reversible allograft
IJ internal jugular dysfunction
IL-​2 interleukin-​2 NTM non-​tuberculous mycobacteria
IL2R interleukin-​2 receptor NT-​proBNP N-​terminal pro-​B type
IL2RA interleukin-​2 receptor natriuretic peptide
antagonist NYHA New York Heart Association
ILD interstitial lung disease OHT orthotopic heart
INR international normalized ratio transplantation
INTERMACS Interagency Registry for PA pulmonary artery
Mechanically Assisted PAC pulmonary artery catheter
Circulatory Support PaCO2 partial arterial pressure of
ISHLT International Society for Heart carbon dioxide
and Lung Transplant PaO2 partial arterial pressure
IV intravenous of oxygen
IVIG intravenous immunoglobulin PCCS post-​cardiotomy
LA left atrial/​atrium cardiogenic shock
LAA left atrial appendage PCO2 partial pressure of carbon
LAS lung allocation score dioxide
LKTx lung–​kidney transplantation PCR polymerase chain reaction
LLTx lung–​liver transplantation PCWP pulmonary capillary wedge
pressure
LV left ventricular/​ventricle
PEEP positive end-​expiratory
LVAD left ventricular assist device pressure
LVEDD left ventricular end-​diastolic PFO patent foramen ovale
diameter
PFT pulmonary function testing
PGD primary graft dysfunction
Another random document with
no related content on Scribd:
 "Yes, faith, I shall creep down."

They left Huntingdon together, Jacob walking by Winter's horse for two
miles. They parted, then, in the gracious glow of evening, and the elder sat
upon a shelf of rock and waited. Far beneath him the sun fires lingered over
the pavilions of a larch grove and warmed the young green to gold. The
untiring cuckoo called a while, then grew silent as twilight stole delicately
over all things and detail died.

He saw Auna at last—slim and swift, ascending on quick feet. And then
she had come, put her arms round his neck, kissed him, and looked into his
eyes with the warmth of her steadfast worship.

"Is your soul quiet now, dear father?" she asked; and he replied:

"Yes, faith, it's quiet now, my dinky maid."

She sighed with satisfaction.

So they went up together, hand in hand, through the cool curtain of

dusk; with fret of light and shadow all vanished for that day. They went up
speaking very few words into the deepening bloom of night, while on the
sky glimmered the stars again, and in the grass a glow-worm. From his
stony place among the fern, churn-owl throbbed a lullaby for the whole,
drowsy earth; and he touched their human hearts, old and young, with the
mystery of his music—the mystery of all living songs that waken when the
rest of the world is going to sleep. The two notes whirred on, rising and
falling, fainting and trembling out again.

Then the white face of Huntingdon looked upon them.

"It shan't be your home much longer—I promise that," he whispered;

but as yet Auna knew no other love than love of him.

"Where you are is my home, father," she said.

PRINTED IN GREAT BRITAIN BY WOODS & SONS, LTD., LONDON, N.1
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