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Published on: June 26, 2020
High-risk heart grafts: effective preservation with Celsior solution
Luca Salvatore De Santo1, Cristiano Amarelli, Gianpaolo Romano
1Department of Cardio-Thoracic and Respiratory Sciences, Second University of Naples, V. Monaldi Hospital, Naples, Italy. lucas.desanto@unina2.it
Insights
Celsior solution effectively preserves hearts for transplantation, even in high-risk cases. This study found comparable outcomes for standard and high-risk grafts, supporting donor pool expansion.
Area of Science:
- Cardiology
- Transplantation Medicine
- Biomedical Engineering
Background:
- Celsior solution is recognized for its efficacy in heart graft preservation.
- It mitigates myocardial edema, oxidative stress, and calcium influx.
- Its role in high-risk heart transplantation requires further evaluation.
Purpose of the Study:
- To assess the effectiveness of Celsior solution for myocardial protection in high-risk heart transplantation.
- To compare graft performance and patient outcomes between high-risk and standard heart transplant recipients.
Main Methods:
- Retrospective review of hospital charts and follow-up data for 200 heart recipients.
- Patients categorized into high-risk (n=73) and standard (n=127) graft groups.
- Graft quality assessed via enzyme release, echocardiography, inotropic support/pacemaker need, and biopsy histology; mortality evaluated.
Main Results:
- No significant differences in hospital or 1-year mortality between high-risk and standard groups (11% vs 6.3% and 15.1% vs 10.2%, respectively).
- Graft performance, including need for inotropic support/pacemaker and echocardiographic parameters (ejection fraction), was comparable.
- Histology and enzyme release patterns showed no significant variations between groups.
Conclusions:
- Celsior solution ensures optimal myocardial preservation in both standard and high-risk heart transplant procedures.
- The findings suggest Celsior solution can aid in expanding the donor heart pool.
- Its use is validated for diverse transplantation scenarios, including those with increased donor-recipient risk factors.
Abstract:
Celsior solution has already proved effective in heart graft preservation because it reduces myocardial edema, prevents free radical damage, and limits calcium overload. The aim of this study was to evaluate the effectiveness of Celsior solution as myocardial protection in high-risk transplantation. Hospital charts and follow-up data of 200 consecutive heart recipients (162 males, 38 females, mean age 47.4 +/- 12.6 years) were reviewed. Patients were divided into two groups: group A (73 patients) included recipients of high-risk grafts (at least two of the following: age >45; female sex; high preretrieval inotropic support, viz. dobutamine or dopamine >10 microg/kg per minute and/or infusion of norepinephrine regardless of its dosage; size mismatch >20%; ischemia time >180 min) and group B (127 patients) included recipients of standard grafts. Quality of preservation was assessed through enzyme release, echocardiographic evaluation, the need for inotropic support or pacemaker, and histology of biopsy samples. Hospital and 1-year mortality were also evaluated. Comparisons between the two groups were made through univariate analysis. Study groups proved homogeneous as to recipient age, pretransplant cardiomyopathy, status at transplantation, mean panel reactive antibodies, and redo cardiac surgery. Hospital mortality was 8% (11% vs 6.3%, P = 0.18) while 1-year mortality reached 12% (15.1% vs 10.2%, P = 0.6) without significant difference between groups. Graft performance as described by the need for inotropic support and/or pacemaker as well as echocardiography (left and right ventricular ejection fraction) proved comparable. There were no significant differences as to histology findings and patterns of enzyme release. Celsior provides optimal myocardial preservation in both standard and high-risk procedures. Such advances help to enhance donor pool expansion.
