Heart–Lung and Lung Transplantation

Heart–lung transplantation (HLT) can be considered for patients with end-stage cardiopulmonary disease that is unresponsive to maximal medical therapy and for which no surgical options exist except combined heart– lung replacement. Increasingly, in an effort to make maximum use of donated organs, double-lung transplantation (DLT) and single- lung transplantation (SLT) are being used for patients with pulmonary disease without secondary severe cardiac dysfunction. Single-lung transplantation (SLT) can be considered for patients with end-stage lung disease without significant cardiac dysfunction. Double-lung transplantation (DLT) is also considered for patients with end-stage pulmonary disease without significant cardiac dysfunction. Only 5% to 20% of all solid organ donors are suitable lung donors. HLT is performed through a median sternotomy with hypothermic cardiopulmonary bypass (CPB), bicaval cannulation, and aortic cross-clamping. Anesthetic techniques should allow for early postoperative extubation. Many patients with end-stage pulmonary disease will be unable to lie flat due to severe dyspnea.