What intraoperative monitors should be used in the patient with a transplanted heart?
In the absence of rejection, graft function is usually fairly good and a noninvasive blood pressure (NIBP) cuff and routine monitors are usually sufficient. Invasive arterial and central venous pressure monitoring are generally only employed if there is hemodynamic instability (e.g., from bleeding, sepsis, myocardial dysfunction, during acute rejection) or if indicated by the planned procedure (e.g., for frequent arterial blood gas sampling during one-lung ventilation, or when one needs to follow and/or optimize filling pressures and indices of cardiac function). It must be remembered that requisite endomyocardial biopsies to monitor rejection are preferentially performed via the right internal jugular (IJ) vein, and one should use the left IJ or subclavian veins for central access if possible. Where avail-able, transesophageal echocardiography (TEE) may be preferable to invasive central monitoring.