1. Orthotopic Heart Transplantation
a) Recipient is placed on bypass in usual fashion
b) Pulmonary artery catheter is withdrawn 15-20 cm
c) Aortic cannulation is performed as distally as possible on the aorta
d) Bicaval cannulas are placed
e) Go on CPB
f) Snares around the venae cavae are tightened thus totally isolating the heart from the systemic circulation
g) Systemic cooling is commenced to 30°C during which recipient heart is resected
h) Aorta & pulmonary arteries are cross-clamped & divided
i) Atria are transected to preserve the AV groove but atrial appendages are discarded
j) Left atria of donor & recipient are anastomosed first, followed by right atria
k) Donor heart is kept cool with cold saline lavage, TCD etc
l) The donor & recipient aortas are joined
m) Rewarm when finishing aortic suture line
n) Aortic cross clamp is removed with patient in head down position
o) Finally, pulmonary artery anastomosis completed
p) Deairing performed
q) Attempts to wean from CPB are begun
r) Isoprenaline infusion begun to counteract usual tendency of bradycardia
2. The left groin is available for emergency cannulation
3. A small catheter is placed in the right superior pulmonary vein for left atrial pressure monitoring
4. The left ventricular apex is vented if necessary