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Utility of Recipient Cardiothoracic Ratio in Predicting Delayed Chest Closure after Heart Transplantation
Amrita Sukhavasi1, Danial Ahmad1, Melissa Austin1
1Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, United States.
The Thoracic and Cardiovascular Surgeon
|January 18, 2023
Summary
The cardiothoracic ratio (CTR) helps guide donor heart oversizing in transplantation. Maintaining the predicted cardiac mass ratio (PCMR) to CTR below 1.7 may prevent delayed chest closure.
Area of Science:
- Cardiology
- Thoracic Surgery
- Transplantation Medicine
Background:
- Predicted cardiac mass (PCM) is validated for donor heart size matching.
- Cardiothoracic ratio (CTR) may indicate recipient limits for donor heart oversizing.
Purpose of the Study:
- To assess the utility of donor-to-recipient predicted cardiac mass ratio (PCMR) and CTR in predicting delayed chest closure after heart transplantation.
Main Methods:
- Retrospective review of 38 heart transplantations (2017-2020).
- Donor and recipient PCM estimated using Multi-Ethnic Study of Atherosclerosis models.
- Receiver operating characteristic analysis to evaluate PCMR/CTR predictive power for delayed sternal closure.
Main Results:
- Median recipient CTR was 0.63; median donor-to-recipient PCMR was 1.07 (7% oversizing).
- 34.2% of patients required delayed sternal closure.
- PCMR/CTR demonstrated strong discriminatory power (AUC 80.4%) for delayed sternal closure, with a cut-off of 1.7 offering 69.6% sensitivity and 91.7% specificity.
Conclusions:
- CTR can guide recipient-specific donor heart oversizing.
- A PCMR/CTR ratio below 1.7 may help avoid excessive donor heart oversizing and subsequent delayed chest closure.
