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Temporal Changes in Left Ventricular Systolic Function and Use of Echocardiography in Adult Heart Donors
Xenia I Borbely1, Vijay Krishnamoorthy, Shan Modi
1Department of Anesthesiology and Pain Medicine, Harborview Medical Center, University of Washington, 325 Ninth Avenue, Box 359724, Seattle, WA, 98104, USA, borbely@u.washington.edu.
Insights
Left ventricular systolic dysfunction is common in brain-dead donors but often resolves with monitoring and support, improving heart transplant rates. Serial echocardiography aids in assessing cardiac function recovery.
Area of Science:
- Cardiology
- Transplantation Medicine
- Critical Care
Background:
- Left ventricular systolic dysfunction affects up to 42% of brain-dead adults, leading to donor heart refusal.
- Serial echocardiography (TTE) and donor management may improve organ procurement rates.
- Understanding cardiac dysfunction post-brain death is crucial for optimizing donor utilization.
Purpose of the Study:
- To determine the prevalence of cardiac dysfunction in adult brain-dead donors.
- To describe longitudinal changes in cardiac function after brain death.
- To evaluate the role of serial TTE in assessing cardiac recovery.
Main Methods:
- Cross-sectional study of adult heart donors diagnosed with brain death (Jan 2011-Nov 2013).
- Analysis of 246 potential donors with at least one TTE post-brain death.
- Review of echocardiograms for cardiac dysfunction (EF <50% and/or regional wall motion abnormalities).
Main Results:
- Cardiac dysfunction was present in 30% (74/246) of donors.
- Significant differences in age, BMI, EF, and organ harvest rates were observed between groups.
- Among 29 donors with initial dysfunction, 52% (15/29) showed resolved dysfunction with serial TTE, enabling organ harvest.
Conclusions:
- The prevalence of cardiac dysfunction following adult brain death is substantial.
- Serial TTE monitoring reveals that many donors experience improved cardiac function over time.
- Optimized donor management and serial TTE can lead to successful heart transplantation.
Background:
One reason for refusal of donor hearts is the development of left ventricular systolic dysfunction, a condition reported to occur in up to 42 % of adults with brain death. Prior studies have suggested that appropriate donor management and evaluation of cardiac dysfunction with serial echocardiography (TTE) can improve organ procurement. The aims of our study are to examine the prevalence and describe longitudinal changes in cardiac dysfunction after brain death.
Methods:
A cross-sectional study was performed using the Life Center Northwest organ database to identify potential adult heart donors diagnosed with brain death between January 2011 and November 2013. 246 potential donors with at least one TTE following brain death were identified. 58 donors received serial TTEs. Echocardiograms were reviewed for cardiac dysfunction, defined as left ventricular ejection fraction (EF) <50 % and/or presence of regional wall motion abnormalities.
Results:
Cardiac dysfunction was present in 74 (30 %) patients. Age, body mass index, EF, and proportion of harvested organs differed significantly between the groups with and without cardiac dysfunction. Among patients receiving serial TTEs, 29 patients had cardiac dysfunction on initial TTE, with 15 (52 %) of these patients demonstrating resolved cardiac dysfunction over time leading to organ harvest.
Conclusions:
To our knowledge, the present study is the largest study describing the use of serial TTE and its utilization in adult donors. The prevalence of cardiac dysfunction after adult brain death is high, but given enough time and support, many of these donors have improvement in cardiac function, ultimately leading to transplantation.
