Abstract
Background: Preservation of cardiac grafts for transplantation is not standardized and most centers use a single administration of crystalloid solution at the time of harvesting. We investigated possible benefits of an additional dose of cardioplegia dispensed immediately before implantation.Methods: Consecutive adult cardiac transplantations (2005–2012) were reviewed. Hearts were harvested following a standard protocol (Celsior 2L, 4–8°C). In 2008, 100 ml crystalloid cardioplegic solution was added and administered immediately before implantation. Univariate and logistic regression analyses were used to investigate risk factors for post-operative graft failure and mid-term outcome.Results: A total of 81 patients, 44 standard (“Cardio−”) vs. 37 with additional cardioplegia (“Cardio+”) were analyzed. Recipients and donors were comparable in both groups. Cardio+ patients demonstrated a reduced need for defibrillation (24 vs. 48%, p = 0.03), post-operative ratio of CK-MB/CK (10.1 ± 3.9 vs. 13.3 ± 4.2%, p = 0.001), intubation time (2.0 ± 1.6 vs. 7.2 ± 11.5 days, p = 0.05), and ICU stay (3.9 ± 2.1 vs. 8.5 ± 7.8 days, p = 0.001). Actuarial survival was reduced when graft ischemic time was >180 min in Cardio− but not in Cardio+ patients (p = 0.033). Organ ischemic time >180 min (OR: 5.48, CI: 1.08–27.75), donor female gender (OR: 5.84, CI: 1.13–33.01), and recipient/donor age >60 (OR: 6.33, CI: 0.86–46.75), but not the additional cardioplegia or the observation period appeared independent predictors of post-operative acute graft failure.Conclusion: An additional dose of cardioplegia administered immediately before implantation may be a simple way to improve early and late outcome of cardiac transplantation, especially in situations of prolonged graft ischemia. A large, ideally multicentric, randomized study is desirable to verify this preliminary observation.
Highlights
Myocardial protection during harvesting, transport, and implantation of cardiac grafts is obviously a critical determinant of posttransplantation outcome
In the current analysis, we aimed at exploring the possible benefit of administrating an additional dose of cardioplegic solution just before starting with the implantation of the graft in terms of myocardial protection and early and mid-term post-operative outcomes
Cardioplegia and cardiac transplantation consent for anonymized observational analyses of their data at the time of surgery and the local ethical committee approved the present investigation as part of our regular institutional quality audit
Summary
Myocardial protection during harvesting, transport, and implantation of cardiac grafts is obviously a critical determinant of posttransplantation outcome. Authors have described, in their methods, the adjunction of complementary doses of cardioplegic solutions administered at the time of implantation [5, 6]. These various strategies have not been systematically evaluated [7]. In the current analysis, we aimed at exploring the possible benefit of administrating an additional dose of cardioplegic solution just before starting with the implantation of the graft in terms of myocardial protection and early and mid-term post-operative outcomes. Preservation of cardiac grafts for transplantation is not standardized and most centers use a single administration of crystalloid solution at the time of harvesting. We investigated possible benefits of an additional dose of cardioplegia dispensed immediately before implantation
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