Conclusion:Thyroid hormone use can have important implications for organ selection and cardiac function before and after transplantation. Protocols vary widely with respect to why and how to use and wean thyroid hormone. We believe there should be more detailed reporting of thyroid hormone use for future studies to ensure appropriate donor management. ( 585)Purpose: Brain-stem-death (BSD) causes cardiac injury and dysfunction that is sometimes reversible. The optimum time after BSD at which to assess the function of donor hearts is unknown. We hypothesized that a longer interval may be associated with a higher transplantation rate due to improved function. Methods: Data on adult DBD solid organ donors were obtained retrospectively from the UK Transplant Registry for the period 1 January 2008 to 31 December 2012. Donors above the age of 65 with a past history of cardiothoracic disease, consent for heart donation was refused or whose cause of death was myocardial infarction were excluded. The time when fixed dilated pupils were first noted in the donor was considered as the time of BSD. Retrieval was defined as the time when the abdominal organs were perfused. Results: BSD to retrieval duration was available for 1,839 donors. Of these donors, 461 (25%) donated their heart. The median (IQR) BSD to retrieval duration was 35.6 hours (27.6, 48.7). BSD to retrieval durations differed (p< 0.0001) depending on the time of day when BSD was diagnosed (separated in to four quartiles). A multivariate logistic regression was then performed. Donor age, blood group, gender, cause of death, heart rate, body mass index, past history of hypertension, cardiac arrest and use of prednisolone were all found to influence the probability of donation. Adjusting for these factors, there was evidence to suggest that the BSD to retrieval duration had a non-linear effect upon heart donation (p= 0.047).The effect was such that, longer durations were associated with a higher probability of donation. However, the odds ratio for the probability of heart donation began to plateau at a value of 1 after approximately 1.5 days suggesting that durations beyond this have no impact on the chance of donation. Analysis of a subset of donors attended by a cardiothoracic retrieval team showed a similar pattern. Conclusion: This data suggest that time interval from BSD to retrieval influences the heart retrieval rate. A longer time interval may allow the heart to recover from the BSD induced injury. When the sole reason for decline a donor heart is poor function, a period of further observation and optimisation up to 1.5 days should be considered.

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patients (80.9%) with a mean age of 53 years were mainly treated with the Medtronic HVAD device (76%). Baseline characteristics including the severity of LV and RV dysfunction (LVEF 19%, TAPSE 16mm Controlgroup) were comparable between both study-groups. There was no difference regarding preoperative LV dilatation (LVEDD 78mm MR-group vs. LVEDD 75mm Control-group; p=0.67). We found significantly increased parameters of mitral leaflet-tethering prior to LVAD implantation within the MR-group (Tenting-height: 11.5mm vs. 7.5mm; p=0.03; Tenting-area: 244mm 2 vs. 178mm 2 ; p=0.04). Tethering of the anterior mitral leaflet (AML) was particularly increased in the MR-group (p=0.02). 12 months after LVAD implantation patients within the MR-group showed a significantly reduced exercise capacity (6-minute walk test: 293m vs. 439m; p=0.04). Overall survival was significantly impaired in the MR-group in comparison to the Control-group (40% vs. 91%; p=0.002). Conclusion: LVAD recipients with persistent MR despite mechanical unloading showed significant echocardiographic signs of mitral leaflet tethering prior to LVAD implantation. Furthermore, persistent MR 12 months after LVAD implantation was associated with a reduced exercise capacity and an impaired overall survival. If correction of preoperative MR improves post implant survival needs to be shown in future studies.

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