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312 P R I N C I P L E S A N D P R A C T I C E O F C R I T I C A L C A R E

FIGURE 12.13 LEFT Completion of bicaval transplant technique, showing the interior vena caval, superior vena caval, aortic, and pulmonary artery anas-
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tomoses RIGHT Commencement of the left artrial anastomosis.

SVC

SVC
AO AO
RA
PA
PA
RV
LV RA
LV

RV
LA appendage
FIGURE 12.14 Chest X-ray showing heterotopic heart transplant. DONOR RECIPIENT

FIGURE 12.15 Heterotopic heart transplant (LVAD configuration).
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postoperative period, transplant recipients are at risk of
developing complications that include hyperacute rejec-
tion, acute rejection, infection, haemorrhage and renal
failure. In the immediate postoperative period, heart
transplant recipients may experience morbidity specific to
the heart transplant procedure, such as early allograft
dysfunction (i.e. organ failure due to preservation injury),
bleeding, right ventricular failure and acute rejection.
Long-term complications include chronic renal failure,
hypertension, malignancy and cardiac allograft vascu-
lopathy. The common immediate potential complica-
tions and associated clinical management for heart FIGURE 12.16 Rhythm strip post orthotopic transplant (standard
recipients are discussed below. technique).