Enbloc Heart and Lung Transplantation – A Case Report

Enbloc heart and lung transplantation is the recommended ultimate option of surgery for candidates suffering from irreversible end stage heart and lung disease. This major surgery requires a cohesive multidisciplinary teamwork approach to yield a favourable outcome. The role of perfusionist is vital in this complex operation who is an active participant in the preoperative period intra-op and post-operative period. Our Enbloc heart and lung experience - case report highlights the key elements of this surgery from the perfusionist perspective. A 68 year old male patient was suffering from end stage heart and lung disease refractory to medical therapy due to worsened interstitial lung disease and coronary artery disease. His life style was restricted and required heart and lung transplantation at the earliest. He got a suitable donor and successfully underwent Enbloc heart and lung transplantation. The donor was a 24 year old male who was in comatose state due to traumatic brain injury. The donor specific antibody test was performed and the report was negative. Cold custodial and Perfadex Plus was administered to the donor heart and lungs and were harvested. The gold standard approach for Enbloc heart and lung transplantation is the median sternotomy. Standard bicaval and aortic cannulation was done and cardiopulmonary bypass was instituted. The total Cardio Pulmonary Bypass time was 250 minutes. Cold cycle was 144 minutes and warm cycle was 75 minutes. Continuous zero balanced ultrafiltration was done to eliminate the inflammatory mediators and to keep the serum lactate within the normal limits. The various perfusion strategies involved in Enbloc heart and lung transplantation and the involvement of perfusionists in the management of these patients is discussed in the article. Enbloc heart and lung transplantation is the treatment of choice for end-stage heart and lung disease. This type of surgery demands a holistic teamwork approach involving a multidisciplinary team and this helped in the speedy recovery of the patient in the case presented.