ABSTRACT
The purpose of this chapter is to address a number of programmatic and patient management issues that do not conveniently fit into the other chapters in this book. The comments in the section on interhospital transfer are primarily directed to the patient with postcardiotomy cardiogenic shock who fails to recover ventricular function and must be transferred from a nontransplant center to a hospital that performs cardiac transplantation. The remarks in this section are also referable to the management of the bridge patient who is cared for in a community located at a distance from the transplant hospital. If the patient is supported with an implantable blood pump and is living at home awaiting a cardiac transplant, device or nondevice related problems may necessitate transfer of the patient back to the implanting facility. Ventricular arrhythmias or native valvular disease may occur in patients requiring mechanical circulatory support either as a bridge to cardiac transplantation or for postcardiotomy cardiogenic shock. The management recommendations for patients with either of these two conditions serve to complement the patient care chapters in this text. Primary right ventricular failure rarely occurs in the bridge or postcardiotomy cardiogenic shock scenario. It is a unique circumstance that warrants comment as many management issues are peculiar to this clinical condition.
