POST- (H)LTX MANAGEMENT
Physiologic changes observed immediately after lung implantation with normalization of PVR should be anticipated; there is an increase in cardiac output and increase in left ventricular (LV) filling with acute LV dilation. This acute change in myocardial length-tension relationship can lead to LV failure. LV failure predisposes to elevation in post-capillary pulmonary vascular pressures which can lead to pulmonary edema and classic features of primary graft dysfunction. At the same time, RV dilation is immediately reduced resulting in a different length-tension alteration which may also compromise RV function, which is commonly compromised going into surgery. Treatment includes protective ventilator strategies, appropriate pressor support and fluid management to maintain normovolemia; beta-blockers may be considered to limit cardiac output. Post-operative ECMO support should be considered within 48 hours for patients with unrelenting low cardiac output and/or low lung compliance requiring PIP > 35 cmH2O and FiO2 >0.6 15. Induction, immunosuppression, prophylaxis and surveillance are not different from patients without PH8.