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Outcome in cardiac recipients of donor hearts with increased left ventricular wall thickness

S S Kuppahally1, H A Valantine, D Weisshaar

  • 1Department of Cardiac Transplant, Stanford University, Stanford, CA, USA. sumans@yahoo.com

American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons
|September 12, 2007
PubMed

Insights

Donor hearts with increased left ventricular wall thickness (LVWT) are associated with poorer cardiac transplant outcomes. Careful selection is crucial, reserving these hearts for the most critically ill recipients to improve survival rates.

Area of Science:

  • Cardiology
  • Transplantation Medicine
  • Echocardiography

Background:

  • Donor heart shortages necessitate using hearts with structural abnormalities.
  • Left ventricular hypertrophy (LVH) is a common abnormality in donor hearts.

Purpose of the Study:

  • To evaluate the impact of donor left ventricular wall thickness (LVWT) on cardiac transplant recipient outcomes.
  • To determine if increased LVWT in donor hearts affects recipient survival and allograft vasculopathy.

Main Methods:

  • Retrospective analysis of 157 cardiac donor-recipient pairs from January 2001 to December 2004.
  • Comparison of outcomes between recipients of donor hearts with increased LVWT (≥1.2 cm) and normal LVWT (<1.2 cm).
  • Cox regression analysis to identify predictors of reduced survival.

Main Results:

  • Recipient survival was significantly lower (50% vs. 82%) in those receiving donor hearts with LVWT > 1.4 cm compared to LVWT ≤ 1.4 cm.
  • Incidence of allograft vasculopathy was higher (50% vs. 22%) in recipients of donor hearts with LVWT > 1.4 cm.
  • Donor LVWT > 1.4 cm, preoperative ventricular assist device (VAD) support, and bypass time > 150 minutes predicted reduced survival.

Conclusions:

  • Donor hearts with echocardiographic evidence of increased LVWT may be associated with poorer post-transplant outcomes.
  • Careful consideration is advised when accepting donor hearts with increased LVWT.
  • These hearts might be best reserved for the most critically ill recipients.

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