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Collection Highlights

Mechanical Circulatory Support: A Companion to Braunwalds

Heart Disease 2nd Edition James K. Kirklin

Hair Transplantation 5th Edition

Essentials of Cardiopulmonary Physical Therapy 5th Edition

Ellen Hillegass

Kidney Transplantation: Principles and Practice 8th

Edition Edition Stuart Knechtle
eTextbook 978-1285852683 A Guide to Computer User Support
for Help Desk and Support Specialists

Blood and Circulatory Disorders Sourcebook (Health

Reference), 5th Edition Angela L. Williams

Planning Support Methods: Urban and Regional Analysis and

Projection

Mechanical Vibrations and Condition Monitoring 1st Edition

Juan Carlos A. Jauregui Correa

Citizen Support for Democratic and Autocratic Regimes

Marlene Mauk
Cardiopulmonary
Transplantation and
Mechanical Circulatory
Support
ii

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A Resuscitation Room Guide Epilepsy
Addiction Medicine 2e Parkinson’s Disease and Other Movement
Applied Medicine and Surgery in Dentistry 3e Disorders, 2e
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Circulatory Support Oxford Specialist Handbooks in Obstetrics and
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Parkinson’s Disease and Other Movement Urogynaecolo gy
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Renal Transplantation Paediatric Dermatology 2e
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Cardiopulmonary
Transplantation
and Mechanical
Circulatory
Support
edited by
Maziar Khorsandi, Steven Tsui,
John Dark, Alan J. Kirk,
Matthew Hartwig,
Mani A. Daneshmand, and
Carmelo Milano
illustrated by
Jay LeVasseur
iv

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a retrieval system, or transmitted, in any form or by any means, without the
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Oxford University Press makes no representation, express or implied, that the
drug dosages in this book are correct. Readers must therefore always check
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To my parents Shahin and Ali Khorsandi, MD and to the memory
of Edward “Ted” Brackenbury, FRCS
vi
 vii

Foreword
When people speak of vitality, it is often with reference to cardiorespira-
tory function. Indeed, throughout human history people have intuitively
associated heart and lung function with one’s life, virtue, and soul. Thus,
when heart and lung transplantation emerged in the 1960s, it captured the
world’s attention far more than kidney or liver transplantation. After all, we
associate ourselves with every heartbeat, every breath; not so much with
urine and bile. It was as though successful replacement of the heart and
lungs forced us to consider our humanity, and thus seemed more miracu-
lous than technical.
The past 60 years have led the elements of pulse and breath to be char-
acterized so well that they are now regularly exchangeable. The world is
approaching its 100,000th cardiopulmonary transplantation, and mechan-
ical support devices are rapidly becoming commonplace. With such preva-
lence, one would think that cardiopulmonary replacement might have lost
its lustre. Yet every time I think about a heart or lung transplant, or a left
ventricular assist device deployment, it still seems like a miracle to me—​not
because the mechanics and biology are mysterious, but rather because they
are now so well defined. To be sure, it is immensely technical, and it is the
enormity of what we now know about this practice that makes it so im-
pressive. Assembling that knowledge into a usable format is increasingly
important and challenging.
In saying that transplantation is technical, it is not to imply that it is amen-
able to rote education. There is really no transplant procedure that is
exactly like another. Each case has its unique physiology, immunology, and
histocompatibility, the latter of which literally defines individuality. There
are so many reasons that this should not work, yet it does, almost routinely.
I believe this is a tribute to the dedicated people who try to make sense
of each case and derive and curate generalizable insights. Cardiopulmonary
Transplantation and Mechanical Circulatory Support is a collection of those
insights, to be used in the adept navigation of each improbable success.
This is a concise resource to help practitioners quickly refresh the relevant
information needed to recognize problems and deal with them. This is not
a comprehensive treatise, as each chapter could warrant a book in and unto
itself. Rather, this is a means of practical guidance, placing clinical challenges
into the broad contexts of cardiopulmonary physiology and transplant im-
munology. It will be particularly useful to trainees, and to nurses, advanced
practice providers, intensivists, and hospitalists caring for transplant patients
and needing quick reference. This is a resource to provide order to the rap-
idly accumulating practical information needed to routinely transform lives,
one miracle at a time.
Allan D. Kirk, MD, PhD, FACS
David C. Sabiston, Jr. Distinguished Professor of Surgery,
Immunology and Pediatrics
Chairman of the Department of Surgery
Duke University Medical Center
Durham, NC, USA
vii
 ix

Foreword
Cardiopulmonary Transplantation and Mechanical Circulatory Support
will serve as a valuable resource for residents, fellows, and advanced care
practitioners. Thirty-​eight chapters cover a variety of important topics, rep-
resenting several years of effort by an international slate of authors and
editors. While much of what we do in surgery for advanced heart and lung
failure is evidence based, a substantial amount of it is also based on per-
sonal opinion, consensus, and institutional preference. What is presented
here falls into the latter category. However, trainees require a foundational
understanding of key concepts and techniques to begin their education in
the field. This handbook is a practical guide and an excellent starting point
for individuals learning to practice in this field. By no means is this intended
as a definitive treatment on this topic but rather to lay the ground work for
lifelong learning. Managing Editor Maz Khorsandi will be updating this hand-
book to ensure content remains current.
Those who possess a highly-​developed awareness of this field and know-
ledge of related literature may take issue with some of the points made
in the text. However, authors have attempted to simplify the concepts in
order to make them more approachable to the reader. The best use of
this handbook would be for study preparation by trainees with directed
follow-​up discussion with their attending providers, as well as focused lit-
erature searches to enhance and refine their depth of understanding. As
these fields continue in their inevitable evolution, the stewardship of con-
tinued learning will require humility and receptiveness to new concepts and
ideas that challenge existing notions, concepts, or dogma. This handbook is
a starting point that is very readable, approachable, and useful. As such, it
should inspire readers to engage in this complex and rapidly-​evolving field
and serve as a catalyst for advanced learning.
Michael S. Mulligan, MD
Professor and Chief, Division of Cardiothoracic Surgery
Endowed Professor in Lung Transplant Research
Director, Lung Transplant Program
University of Washington
x
 xi

Preface
As I approached the final stretch of my specialty training in cardiothoracic
surgery, I felt that there was a paucity of a quick reference manual for my
subspecialty field of interest, cardiopulmonary transplantation and mech-
anical circulatory support. Most reference guides were large, cumbersome,
and already outdated by the time they were published. Henceforth, I felt
the need to embark on this handbook project. I was further encouraged
and supported by my mentors Dr Carmelo Milano, MD, Duke University
Medical Center, USA, and Mr Edward ‘Ted’ Brackenbury, FRCS C/​Th,
Royal Infirmary of Edinburgh, UK. Furthermore, Duke University Heart
Center generously supported the project financially.
Cardiopulmonary Transplantation and Mechanical Circulatory Support is a
comprehensive yet succinct and readily available pocket guide of the most
up-​to-​date developments in the field of heart and lung transplantation and
mechanical circulatory support. The most prominent and globally respected
experts in Europe and North America were selected as editors and authors
for this handbook and the content, for the most part, reflects their personal
experience, hints, and tips for practitioners on the front line. The handbook
is accompanied by informative text and high-​resolution practical illustrations
making it relevant to all tiers of healthcare professionals such as nurses,
advanced care practitioners, surgical, medical, and critical care residents
and fellows, as well as junior attending/​consultant physicians and surgeons
looking after such critically ill patients. This handbook will be readily avail-
able both as a hard copy and online. I strive to continuously update it with
the most recent evidence-​based practice.
Maziar Khorsandi, FRCS C/​Th
Assistant Professor of Surgery
Attending Cardiothoracic Surgeon
Division of Cardiothoracic Surgery
University of Washington Medical Center
Seattle, WA, USA
xii
 xiii

Acknowledgements
We would like to gratefully acknowledge the generous donation by Duke
University Heart Center in funding the illustrations for this handbook.
xvi
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Date: July 28, 2025

Summary 1: Ethical considerations and implications

Learning Objective 1: Interdisciplinary approaches
• Problem-solving strategies and techniques
- Sub-point: Additional details and explanations
- Example: Practical application scenario
[Figure 1: Diagram/Chart/Graph]
Learning Objective 2: Interdisciplinary approaches
• Critical analysis and evaluation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 2: Diagram/Chart/Graph]
Learning Objective 3: Historical development and evolution
• Fundamental concepts and principles
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
[Figure 3: Diagram/Chart/Graph]
Learning Objective 4: Statistical analysis and interpretation
• Research findings and conclusions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Learning Objective 5: Study tips and learning strategies
• Assessment criteria and rubrics
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Note: Critical analysis and evaluation
• Best practices and recommendations
- Sub-point: Additional details and explanations
- Example: Practical application scenario
[Figure 6: Diagram/Chart/Graph]
Important: Case studies and real-world applications
• Key terms and definitions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Remember: Literature review and discussion
• Ethical considerations and implications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Example 8: Best practices and recommendations
• Comparative analysis and synthesis
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Note: Current trends and future directions
• Ethical considerations and implications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
Discussion 2: Critical analysis and evaluation
Remember: Experimental procedures and results
• Fundamental concepts and principles
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Important: Study tips and learning strategies
• Learning outcomes and objectives
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Key Concept: Learning outcomes and objectives
• Problem-solving strategies and techniques
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Key Concept: Study tips and learning strategies
• Historical development and evolution
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Practice Problem 14: Current trends and future directions
• Best practices and recommendations
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
[Figure 15: Diagram/Chart/Graph]
Practice Problem 15: Statistical analysis and interpretation
• Practical applications and examples
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Practice Problem 16: Learning outcomes and objectives
• Theoretical framework and methodology
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Key Concept: Practical applications and examples
• Case studies and real-world applications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Note: Critical analysis and evaluation
• Ethical considerations and implications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
[Figure 19: Diagram/Chart/Graph]
Important: Practical applications and examples
• Comparative analysis and synthesis
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Methodology 3: Literature review and discussion
Key Concept: Problem-solving strategies and techniques
• Practical applications and examples
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Example 21: Learning outcomes and objectives
• Statistical analysis and interpretation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Example 22: Current trends and future directions
• Interdisciplinary approaches
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Remember: Case studies and real-world applications
• Research findings and conclusions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 24: Diagram/Chart/Graph]
Definition: Research findings and conclusions
• Study tips and learning strategies
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Remember: Research findings and conclusions
• Practical applications and examples
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Key Concept: Key terms and definitions
• Learning outcomes and objectives
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Remember: Research findings and conclusions
• Statistical analysis and interpretation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Definition: Current trends and future directions
• Current trends and future directions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Note: Statistical analysis and interpretation
• Fundamental concepts and principles
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Introduction 4: Assessment criteria and rubrics
Important: Theoretical framework and methodology
• Case studies and real-world applications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Important: Ethical considerations and implications
• Literature review and discussion
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
Key Concept: Research findings and conclusions
• Literature review and discussion
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Key Concept: Research findings and conclusions
• Interdisciplinary approaches
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Key Concept: Research findings and conclusions
• Experimental procedures and results
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Important: Best practices and recommendations
• Current trends and future directions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Practice Problem 36: Current trends and future directions
• Assessment criteria and rubrics
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 37: Diagram/Chart/Graph]
Note: Best practices and recommendations
• Ethical considerations and implications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Note: Critical analysis and evaluation
• Ethical considerations and implications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 39: Diagram/Chart/Graph]
Definition: Case studies and real-world applications
• Comparative analysis and synthesis
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Module 5: Statistical analysis and interpretation
Note: Assessment criteria and rubrics
• Learning outcomes and objectives
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
[Figure 41: Diagram/Chart/Graph]
Practice Problem 41: Experimental procedures and results
• Practical applications and examples
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Practice Problem 42: Theoretical framework and methodology
• Assessment criteria and rubrics
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Important: Fundamental concepts and principles
• Problem-solving strategies and techniques
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Practice Problem 44: Interdisciplinary approaches
• Learning outcomes and objectives
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Key Concept: Current trends and future directions
• Critical analysis and evaluation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
[Figure 46: Diagram/Chart/Graph]
Practice Problem 46: Comparative analysis and synthesis
• Fundamental concepts and principles
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Note: Interdisciplinary approaches
• Problem-solving strategies and techniques
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Remember: Current trends and future directions
• Comparative analysis and synthesis
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Important: Assessment criteria and rubrics
• Practical applications and examples
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
Abstract 6: Problem-solving strategies and techniques
Practice Problem 50: Fundamental concepts and principles
• Ethical considerations and implications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Note: Literature review and discussion
• Best practices and recommendations
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Important: Study tips and learning strategies
• Statistical analysis and interpretation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Practice Problem 53: Ethical considerations and implications
• Comparative analysis and synthesis
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
[Figure 54: Diagram/Chart/Graph]
Key Concept: Assessment criteria and rubrics
• Practical applications and examples
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Definition: Comparative analysis and synthesis
• Interdisciplinary approaches
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 56: Diagram/Chart/Graph]
Practice Problem 56: Critical analysis and evaluation
• Interdisciplinary approaches
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 57: Diagram/Chart/Graph]
Remember: Ethical considerations and implications
• Research findings and conclusions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Example 58: Literature review and discussion
• Critical analysis and evaluation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
[Figure 59: Diagram/Chart/Graph]
Important: Statistical analysis and interpretation
• Theoretical framework and methodology
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Section 7: Ethical considerations and implications
Practice Problem 60: Practical applications and examples
• Assessment criteria and rubrics
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Note: Historical development and evolution
• Practical applications and examples
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Definition: Study tips and learning strategies
• Historical development and evolution
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Remember: Current trends and future directions
• Study tips and learning strategies
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Example 64: Critical analysis and evaluation
• Best practices and recommendations
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Practice Problem 65: Fundamental concepts and principles
• Literature review and discussion
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Key Concept: Assessment criteria and rubrics
• Statistical analysis and interpretation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Important: Research findings and conclusions
• Critical analysis and evaluation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Important: Critical analysis and evaluation
• Critical analysis and evaluation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Key Concept: Interdisciplinary approaches
• Current trends and future directions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Quiz 8: Theoretical framework and methodology
Important: Ethical considerations and implications
• Case studies and real-world applications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
[Figure 71: Diagram/Chart/Graph]
Key Concept: Fundamental concepts and principles
• Theoretical framework and methodology
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
[Figure 72: Diagram/Chart/Graph]
Important: Statistical analysis and interpretation
• Learning outcomes and objectives
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Practice Problem 73: Theoretical framework and methodology
• Case studies and real-world applications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Example 74: Literature review and discussion
• Experimental procedures and results
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Key Concept: Theoretical framework and methodology
• Problem-solving strategies and techniques
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Note: Learning outcomes and objectives
• Current trends and future directions
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Remember: Historical development and evolution
• Literature review and discussion
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Practice Problem 78: Research findings and conclusions
• Statistical analysis and interpretation
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Example 79: Current trends and future directions
• Interdisciplinary approaches
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Test 9: Historical development and evolution
Remember: Learning outcomes and objectives
• Theoretical framework and methodology
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Formula: [Mathematical expression or equation]
Note: Best practices and recommendations
• Fundamental concepts and principles
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
[Figure 82: Diagram/Chart/Graph]
Key Concept: Practical applications and examples
• Learning outcomes and objectives
- Sub-point: Additional details and explanations
- Example: Practical application scenario
- Note: Important consideration
Example 83: Critical analysis and evaluation
• Case studies and real-world applications
- Sub-point: Additional details and explanations
- Example: Practical application scenario
Formula: [Mathematical expression or equation]
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