Cardioplegia Solution Related Ventricular Pacing Following Orthotopic Heart Transplantation

Abstract

<h3>Purpose</h3> Multiple solutions are used for heart allograft preservation. University of Wisconsin (UW) remains the most widely used, although there has been increased utilization of histidine-tryptophan-ketoglutarate (HTK). This study investigated differences in the use of postoperative ventricular pacing (VP) at a single center following a change in allograft preservation from UW to HTK . <h3>Methods</h3> We conducted a retrospective study of 42 consecutive patients who underwent orthotopic heart transplantation between January 2017 and December 2018. 21 patients received UW-preserved allografts followed by 21 patients who received HTK-preserved allografts. Patient characteristics, comorbidities and complications were reviewed. Duration of VP and inotropic infusions in the postoperative period were compared between the two groups, UW and HTK. <h3>Results</h3> Table 1 shows pretransplant use of anti-arrhythmics and mechanical support and duration of inotropic support posttransplantation. Figure 1 graphs the number of patients requiring VP from postoperative day 0 to 15. Despite supplemental inotropy in all patients, there was a higher incidence of VP in the first 24 hours in the HTK group compared to UW (43% vs 5%, p=0.01). Preoperative amiodarone use did not correlate with incidence of VP. No patients required a permanent pacemaker. <h3>Conclusion</h3> Multiple studies have been performed investigating the impact of preservation solutions on heart transplant outcomes with mixed results. This hypothesis generating study suggests a higher incidence of bradyarrhythmias requiring VP in HTK-preserved allografts, warranting validation in larger datasets.