**9. Infection control**

Standard prophylaxis is due to cefuroxime 2 g iv every 6 hours in the first 24 hours from heart transplantation (the first two boluses are given in the operating room, at the induction of general anesthesia and once CPB is started). The amount of antibiotic given in the ICU should be tailored for the patient's creatinine clearance, especially if the patient is not under renal filter. Further extension and change of antibiotic therapy should depend on microbiological results of the donor and on microbiological samples of the recipient once admitted in the ICU. Furthermore, in case of redo-operation with existing wound infection, the patient will receive vancomycin and meropenem as standard medication and vancomycin plasma levels should be tested daily. Obviously, due to the immunosuppressive therapy, transplanted patients are very prone to infections. Delivery of care should be done in sterile conditions and, besides standard iv antibiotic therapy, topical antifungal medications should be given in the early postoperative period.

Recipient-related risk factors may be:

• Uncontrolled diabetes (doubled risk)

amount of blood products given.

only emergency treatment.

*11.1.2. Preoperative evaluation*

Technical risk factors are:

predictor of PGD.

• High vasoactive or inotropic support (doubled risk)

intra-aortic balloon pump (IABP) placement may help.

**11.1. Anesthesia and intensive care management**

more complex and creates a unique scenario [24].

pathology and the possible related comorbidities.

*11.1.1. For cardiac transplantation in pediatrics*

• Warm ischemic time (= explant time + implant time); implant time was found to be a strong

Anesthesia and Intensive Care Management for Cardiac Transplantation

http://dx.doi.org/10.5772/intechopen.79837

147

• Resternotomy (it has been identified as a risk factor for severe PGD due to adherences and tissue fibrosis that can extend the explant time and increase the risk of infections).

• Prolonged CPB time, with subsequent systemic inflammatory response, vasoplegia, clotting and platelet dysfunction, leukocyte activation, free oxygen radical release, and larger

All these factors can increase the ischemic-reperfusion injury and the overall mortality [23].

The first step to treat a PDG is vasoactive and inotropic support. If it were not sufficient, an

In case of very severe PGD, an extracorporeal membrane oxygenation (ECMO) becomes the

Pediatric heart transplant represents a small subgroup (14%) of total cardiac transplant where the differences in anatomy and physiology make the surgical procedure and the management

The management of pediatric patients undergoing cardiac transplantation differs from the adult patients because it requires a specific knowledge of physiology and physiopathology at

This heterogeneous population with a wide range of age, genetic disorders, anatomical anomalies, and symptoms can be classified in four different groups based on the different etiology: 1—CHD (congenital heart disease); 2—DCM (dilated cardiomyopathy); 3—RETX

The preoperative evaluation is an essential step in order to better analyze both the cardiac

different stages of growth, from the newborns through childhood up to adulthood.

(retransplant); 4—OTHER (**Table 7**) [25]; each of these has specific features.
