Recipient and surgical factors trigger severe primary graft dysfunction after heart transplant

Benck, Lillian; Kransdorf, E.; Emerson, Dominic; Rushakoff, Joshua A.; Kittleson, M.; Klapper, Ellen; Megna, D.; Esmailian, F.; Halprin, Chelsea; Trento, Alfredo; Ramzy, Danny; Czer, L.; Chang, D.; Ebinger, Joseph; Kobashigawa, J.A.; Patel, Jignesh

doi:10.1016/j.healun.2021.06.002

Cited by 25 publications

(10 citation statements)

References 32 publications

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“…In this study, the rate of ECMO support was 23.5%, which was within the wide range from 2.1% to 31.6% as reported in previous studies [12][13][14][15][16]. Our institution adopts an active, prompt protocol and initiates ECMO support for almost every recipient with signifcant graft dysfunction, which may contribute to the high ECMO rate.…”

Section: Discussionsupporting

confidence: 80%

Mildly Elevated Pulmonary Artery Systolic Pressure is Associated with Extracorporeal Membrane Oxygenation Support after Heart Transplantation

Cui

et al. 2023

Journal of Cardiac Surgery

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Background. Pulmonary hypertension is a well-known risk factor for hemodynamic instability after heart transplantation. However, it remains unclear whether a mild elevation of pulmonary artery systolic pressure (PASP) is associated with higher risks of graft dysfunction and resultant extracorporeal membrane oxygenation (ECMO) support. Methods. From 2016 to 2021, 102 adult recipients undergoing orthotopic heart transplantation at our institution were investigated (mean age, 48.5 ± 13.2 years; 22.5% female). This study cohort was stratified into 3 groups based on the PASP measured by right heart catheterization before surgery: >50 mmHg, 35–50 mmHg, and <35 mmHg. The primary end point was ECMO support after procedure. Results. ECMO was implemented in 24 (23.5%) patients due to difficult weaning from cardiopulmonary bypass or cardiac low output in the intensive care unit, which was likely to be associated with higher mortality ( P = 0.053 ). Age, gender, comorbidities, preoperative medications, and graft ischemia time were comparable across the 3 groups. The use of ECMO was significantly more common in patients with baseline PASP >50 mmHg (11/36, 30.6%) and 35–50 mmHg (12/38, 31.6%), while only 1 (3.6%) patient with baseline PASP <35 mmHg required ECMO support after transplant ( P = 0.007 ). Multivariate logistic models demonstrated that PASP (odds ratio = 2.34; P = 0.028 ) and cardiopulmonary bypass time (odds ratio = 1.01; P < 0.001 ) were independent risk factors for postoperative ECMO. Conclusions. A mild elevation of pretransplant PASP (e.g., 35–50 mmHg) is related to low cardiac output and subsequent ECMO after heart transplantation, for which prompt administration of vasodilators before transplant may be protective.

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Section: Discussionsupporting

confidence: 80%

Mildly Elevated Pulmonary Artery Systolic Pressure is Associated with Extracorporeal Membrane Oxygenation Support after Heart Transplantation

Cui

et al. 2023

Journal of Cardiac Surgery

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“… 1 However, the success of heart transplantation continues to be limited by a paucity of donor organs and suboptimal transplant outcome. 2 , 3 , 4 In the current practice, the majority of donor organs are procured after being flushed with a cold preservation solution and then undergo static cold storage. Finally, all the organs are implanted under hypothermic and ischaemic conditions.…”

Section: Introductionmentioning

confidence: 99%

Transplantation of a beating heart: A first in man

Yin

Rong

Chen

et al. 2022

The Lancet Regional Health - Western Pacific

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“…In addition, recipient and operative factors are important predictors of severe primary graft dysfunction and could interact with size matching. 9 Future work into donor-recipient matching should evaluate recipient and operative variables such as pulmonary vascular resistance and anticipated ischemic time.…”

Section: Discussionmentioning

confidence: 99%

“…However, such studies are likely to be confounded by the changes in organ allocation systems and the COVID‐19 pandemic, both of which have occurred in this time. In addition, recipient and operative factors are important predictors of severe primary graft dysfunction and could interact with size matching 9 . Future work into donor–recipient matching should evaluate recipient and operative variables such as pulmonary vascular resistance and anticipated ischemic time.…”

Section: Discussionmentioning

confidence: 99%

Validation of predicted heart mass equations by measurement of donor heart mass at time of heart transplantation

Cheshire

Quigley

Claydon

et al. 2022

Clinical Transplantation

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Predicted heart mass (PHM) equations may be used in donor-recipient size matching in heart transplantation. We compared PHM and actual heart mass in 25 consecutive DBD heart transplants. There was a moderate positive correlation between actual heart mass and PHM. There was a similar moderate correlation between actual heart mass and donor weight or donor body surface area but not donor height. PHM was lower than actual heart mass for all donor hearts. Bland-Altman analysis showed a systematic bias between PHM and actual heart mass, with a mean difference of 190.9 ± 66.4 g. The utility of PHM equations is likely to be part of a multi-parametric assessment of the relative differences between donor and recipient, so the absolute difference is likely to be unimportant.

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Recipient and surgical factors trigger severe primary graft dysfunction after heart transplant

Cited by 25 publications

References 32 publications

Mildly Elevated Pulmonary Artery Systolic Pressure is Associated with Extracorporeal Membrane Oxygenation Support after Heart Transplantation

Mildly Elevated Pulmonary Artery Systolic Pressure is Associated with Extracorporeal Membrane Oxygenation Support after Heart Transplantation

Transplantation of a beating heart: A first in man

Validation of predicted heart mass equations by measurement of donor heart mass at time of heart transplantation

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