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Value of postoperative assessment of cardiac allograft function by transesophageal echocardiography
D M Kaye1, P Bergin, M Buckland
1Heart and Heart-Lung Replacement Service, Alfred Hospital, Melbourne, Australia.
Insights
Early heart transplant allograft function, measured by left ventricular fractional shortening, predicts the need for inotropic support. Lower fractional shortening indicates higher likelihood of requiring interventions post-transplant.
Area of Science:
- Cardiology
- Transplantation Medicine
- Echocardiography
Background:
- Heart transplantation is a vital treatment for end-stage heart disease.
- While outcomes have improved, early complications remain a challenge.
- Predicting early post-transplant outcomes is crucial for patient management.
Purpose of the Study:
- To identify predictors of early outcome after orthotopic heart transplantation.
- To assess allograft function in the immediate postoperative period.
- To correlate echocardiographic and hemodynamic data with clinical outcomes.
Main Methods:
- Transesophageal echocardiography measured left ventricular fractional shortening 30 minutes post-bypass in 16 heart transplant recipients.
- Standard hemodynamic indexes were recorded.
- Early outcomes included inotropic support duration/dose, mechanical support, and ICU stay.
Main Results:
- Lower left ventricular fractional shortening (28.4% vs 43.7%) was observed in patients needing inotropic support (p < 0.05).
- Fractional shortening negatively correlated with inotrope dose (r = -0.87) and duration (r = -0.62).
- Longer allograft ischemic times (259 vs 138 minutes) were associated with requiring inotropes (p < 0.01).
Conclusions:
- Left ventricular fractional shortening is a sensitive early indicator of allograft function post-transplant.
- Hemodynamic variables were less effective in predicting early outcomes.
- Allograft ischemic time is a significant factor influencing the need for inotropic support.
Abstract:
Heart transplantation now provides an acceptable therapy for patients with severe end-stage heart disease. Although patient outcome has significantly improved both early and late after heart transplantation, early morbidity and mortality continues to affect overall survival and may be unpredictable. In an attempt to identify factors that may assist in predicting early outcome after orthotopic heart transplantation, we assessed allograft function in 16 patients in the immediate postoperative period, 30 minutes after weaning from cardiopulmonary bypass by measuring the fractional shortening of the left ventricle with transesophageal echocardiography. In addition, standard hemodynamic indexes of allograft function (arterial blood pressure, pulmonary capillary wedge pressure, mean pulmonary artery pressure, and cardiac output) were obtained at this early time point. Early outcome was assessed by the duration and peak dose of inotrope support required after transplantation, requirement for mechanical support, and the duration of stay in the intensive care unit. Left ventricular fractional shortening 30 minutes after cardiopulmonary bypass was significantly lower in those patients requiring inotropic support (28.4% +/- 4.6% versus 43.7% +/- 3.5%, p < 0.05), whereas hemodynamic variables failed to distinguish these groups. In those patients requiring inotropes, there was a significant negative correlation of fractional shortening with the peak dose (r = -0.87, p < 0.01) and the duration of inotropic support (r = -0.62, p < 0.05). The total ischemic time of the allograft (206 +/- 22 minutes, range 77 to 359) did not correlate with the subsequent fractional shortening, but patients requiring inotrope support after the operation had significantly longer ischemic times (259 +/- 22 versus 138 +/- 22 minutes, p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)