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Does the solution used for cold static storage of hearts impact on heart transplant survival?
1Department of Clinical Services, Fiona Stanley Hospital, Perth, WA, Australia.
Insights
The choice of cardiac preservation solution significantly impacts heart transplant survival, especially for extended cold ischaemic times. University of Wisconsin solution is preferred for high-risk grafts and longer storage durations.
Area of Science:
- Cardiac Surgery
- Transplantation Medicine
- Cardiovascular Research
Background:
- Donor heart preservation is crucial for successful heart transplantation.
- Various cardiac preservation solutions are employed for cold static storage.
- The impact of these solutions on long-term transplant outcomes requires clarification.
Purpose of the Study:
- To evaluate the effect of different cardiac preservation solutions on heart transplant survival.
- To identify optimal preservation strategies based on cold ischaemic times and graft quality.
Main Methods:
- Systematic review of 182 identified papers, focusing on 9 representing the best evidence.
- Analysis of studies examining cardiac preservation solutions for cold static storage of donor hearts.
- Tabulation of study characteristics, outcomes, and results.
Main Results:
- Long-term survival outcomes are similar across common solutions for shorter cold ischaemic times.
- Unspecified cardioplegia with high potassium is associated with worse outcomes.
- Intracellular solutions (e.g., University of Wisconsin) may offer better short-term survival than extracellular solutions.
- University of Wisconsin solution is recommended for extended ischaemic times (>4 hours) or high-risk grafts.
Conclusions:
- Cardiac preservation solution choice can influence heart transplant survival and secondary outcomes.
- Specific solutions like University of Wisconsin demonstrate benefit in challenging preservation scenarios.
- Evidence does not support unspecified cardioplegia as a final storage solution.
Abstract:
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'For the [cold static storage of donor hearts] does the [cardiac preservation solution] impact on [heart transplant survival]?'. Altogether 182 papers were found using the reported search, of which 9 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. A wide variety of both custom and standardized cardiac preservation solutions are used for the procurement and cold static storage of donor hearts. In heart transplants with shorter cold ischaemic times, survival outcomes appear similar across many of the common cardiac preservation solutions in the long term. However, unspecified cardioplegia (with supraphysiological potassium concentration) is not supported as the final storage solution as it was associated with worse outcomes overall. In the short term, intracellular solutions (<70 mEq/l sodium; including University of Wisconsin solution) may also have better survival outcomes than extracellular solutions. Where extended ischaemic times (>4 h) are necessary or high-risk grafts obtained, the evidence supports University of Wisconsin as the preferred solution. We concluded that choice of cardiac preservation solution could impact both survival and secondary outcomes.
