Donor organ preservation in high-risk cardiac transplantation

To evaluate safety and efficacy of blood cardioplegia in a retrospective selected (but not randomized) donor/recipient population as standard organ preservation technique in high-risk heart transplants (HTX).

The rationale of different strategies was based on both donor and recipient evaluations. Unstable donors with a long history of well-known risk factors and/or long-distance retrieval were given blood cardioplegia, particularly for HTX candidates in poor preoperative clinical condition. Organ protection was performed by administration of St Thomas II crystalloid cardioplegia in 74 patients (group 1) while 58 others (group 2) received blood cardioplegia.

Groups I versus II shows comparable results for immediate postoperative mortality rates (4% vs 7%, P =.4), high doses of inotropic drug support (48% vs 20%, P =.08), and the need for postoperative mechanical assistance devices (9% vs 4.5%, P =.4). In contrast statistically significant differences were observed for occurrence of acute right ventricular failure (50% vs 5%; P =.004), atrioventricular conduction disturbances (63% vs 10%, P =.003), spontaneous sinus rhythm recovery (18% vs 64% P =.0038) and reperfusion interval (RI) (time between removal of aortic cross-clamp and discontinuation of extracorporeal circulation (ECC)) exceeding 30 minutes (70% vs 21%, P =.0004). Higher peak creatine kinase MB mean value (176 +/- 23 vs 90 +/- 19, P =.06) indicated more severe ischemic damage among G1 patients.

This study suggests that high-risk heart transplant candidates benefit from blood cardioplegia, due to the reduced incidence of both right ventricular failure and severe cardiac arrhythmia. Potential limitations to this novel technique may be linked to the higher expenses due to the need for a perfusion technician. Improved myocardial protection can be seen even in a longitudinal study on chronic rejection: this form of allograft protection may preserve the matrix and the endothelium.