Functional state of the cardiorespiratory system after orthotopic heart transplantation with prolonged cold ischemia time

Abstract

Objective: to assess the functional state of the cardiorespiratory system in the long term after orthotopic heart transplantation (HT) with prolonged cold ischemia time. Materials and methods. The results of 60 orthotopic HTs performed at Meshalkin National Medical Research Center were analyzed. A comparison was made of the immediate and long-term outcomes of HTs in the group with cold ischemia time lasting for less than 240 minutes and in those with farther distance between donor and recipient sites with cold ischemia time of 240 minutes or more. In the long-term follow-up after HT, all patients underwent cardiopulmonary exercise testing, body plethysmography, assessment of the diffusing capacity of the lungs, and quality of life assessment. Results. Prolonged cold ischemia showed a negative effect on the early postoperative period – decreased myocardial contractility on postoperative day 1 and longer duration of inotropic support. At the same time, the survival rate and incidence of graft rejection reactions in the early and late post-HT periods in the studied groups did not differ significantly. Peak oxygen consumption in the general group in the long term after HT was 17 (14.7–21.0) mL/kg/min, VE/ VCO2 slope was 30 (29–36) at 100 (90–120) W threshold load power. All the parameters of pulmonary function tests did not differ significantly depending on cold ischemia duration. Quality of life also did not show significant differences depending on the duration of graft ischemia in terms of both physical and psycho-emotional health components of the SF-36 questionnaire. Conclusion. Long-term cold ischemia of the graft did not show any negative impact on the functional state of the cardiorespiratory system and quality of life in the long term after HT. The studied group of recipients was characterized by high efficiency of pulmonary ventilation and gas exchange, as well as high tolerance to physical activity in the long-term post-HT period.