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Donor-heart evaluation by monitoring the left ventricular pressure-volume relationship: clinical observations
Y Yokoyama1, D K Cooper, H Sasaki
1Oklahoma Transplantation Institute, Baptist Medical Center, Oklahoma City.
Insights
Assessing donor hearts using left ventricular pressure-volume loops revealed ventriculoarterial coupling (Ea/Ees) as a key predictor of cardiac performance post-transplantation. This method surpasses traditional hemodynamic measures for evaluating donor heart viability.
Area of Science:
- Cardiology
- Transplantation Medicine
- Cardiovascular Physiology
Background:
- Donor heart selection is critical for successful transplantation.
- Traditional methods for assessing donor heart function pre-transplant have limitations.
- Left ventricular pressure-volume (PV) relationship offers insights into cardiac mechanics.
Purpose of the Study:
- To evaluate the predictive value of left ventricular pressure-volume (PV) relationship measurements for donor heart performance post-transplantation.
- To compare the efficacy of PV loop analysis with standard hemodynamic parameters and dopamine requirements in predicting cardiac function.
Main Methods:
- Fourteen donor hearts were assessed using a microtipped manometer/conductance catheter for left ventricular PV loop measurements.
- Cardiac performance was measured by isoproterenol dose 24 hours post-transplantation.
- Multiple linear regression analysis was used to identify predictors of cardiac performance.
Main Results:
- Ventriculoarterial coupling (Ea/Ees ratio) and myocardial ischemic time were significant predictors of post-transplantation cardiac performance.
- Dopamine requirement and basic hemodynamic parameters did not predict cardiac performance.
- Hearts with an Ea/Ees ratio < 1.0 demonstrated good early and late function, while those with Ea/Ees > 1.0 were deemed unsuitable.
Conclusions:
- Measurement of the left ventricular pressure-volume relationship, specifically ventriculoarterial coupling (Ea/Ees), is a clinically useful predictor of donor heart performance.
- PV loop analysis provides superior predictive value compared to standard hemodynamic assessments for donor hearts.
- This technique can aid in selecting optimal donor hearts for transplantation, improving patient outcomes.
Abstract:
Fourteen donor hearts were assessed by measurement of dopamine requirement, basic hemodynamic parameters (for example, systolic blood pressure), and the left ventricular pressure-volume relationship. The latter function was measured by a combination microtipped manometer/conductance catheter placed in the left ventricle through the ascending aorta. With an isoproterenol dose 24 hours after transplantation as the measure of cardiac performance, multiple linear regression analysis indicated that the ratio of arterial elastance (Ea) to left ventricular end-systolic elastance (Ees), ventriculoarterial coupling (Ea/Ees), and myocardial ischemic time were good predictors of posttransplantation cardiac performance. Dopamine requirement and basic hemodynamic data were not. Twelve implanted hearts showed an Ea/Ees of less than 1.0 and showed good early (less than 24 hours) and late function. Two hearts considered on clinical grounds to be unsuitable for transplantation showed an Ea/Ees of more than 1.0. The data suggest that measurement of the left ventricular pressure-volume relationship would appear to be a clinically useful predictor of donor-heart performance after transplantation.