En Block Harvest and Transplant 1 and Important Issues

Steps of En Bloc Heart–Lung Harvest and Transplant 

1. Donor Harvest Preparation: 

Perform a median sternotomy and open the pericardium to expose the heart and lungs.Administer systemic heparinization to prevent thrombosis.Identify and mobilize the aorta, superior and inferior vena cavae, pulmonary arteries and veins, and the trachea down to the carina.

2. Organ Preservation:

Initiate cardioplegia to arrest the heart.Flush the pulmonary circulation with cold preservation solution through the main pulmonary artery while venting the left atrium to prevent distension.Cool the organs topically with ice slush for myocardial and pulmonary protection.

3. En Bloc Organ Retrieval:

Transect the aorta just distal to the aortic arch branches and divide both vena cavae.Transect the trachea approximately 1–2 cm above the carina.Remove the heart and lungs as a single block and place them in cold preservation solution for transport.

4. Recipient Preparation:

Perform median sternotomy and establish cardiopulmonary bypass.Mobilize and excise the diseased heart and lungs en bloc by dividing the great vessels and trachea similarly to the donor dissection.

5. En Bloc Implantation:

Position the donor heart–lung block in the thoracic cavity.Sequentially perform the anastomoses: left atrial cuff, pulmonary artery, aorta, and trachea.Deair the graft, gradually restore perfusion, and wean the patient from bypass while monitoring for hemodynamic and ventilatory stability.

6. Final Steps:

Recheck hemostasis, chest tube placement, and graft perfusion.Close the chest in standard fashion once satisfactory function and stability are achieved.