Preoperative assessment and management of pediatric heart transplantation

The period of preoperative management of the pediatric cardiac transplant p atient can be divided into three phases: determination of transplant feasib ility, listing, and medical management. Chronic infection, irreversible ele vation of pulmonary vascular resistance, and intractable disease in other o rgan systems may all be contraindications for transplantation. The United N etwork for Organ Sharing has recently changed its listing guidelines. Adole scent donors are now preferentially, to some extent, allocated to adolescen t recipients. Management of pediatric patients awaiting cardiac transplanta tion encompasses optimization of cardiac output through the use of vasodila tors and oral and intravenous inotropic agents. For those patients listed f or transplantation who have single ventricle lesions, such as hypoplastic l eft heart syndrome, management of heart failure also includes balancing sys temic and pulmonary blood flows. Mechanical support of the circulation with extracorporeal membrane oxygenation or ventricular assist devices can be u sed as a bridge to transplant in pediatric patients. (C) 2000 Elsevier Scie nce Ireland Ltd. All rights reserved.