Transplantation of hearts after arrest and resuscitation. Early and long-term results
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J A de Begona1, S R Gundry, A J Razzouk
1Department of Surgery, School of Medicine, Loma Linda University Medical Center, Calif. 92354.
Insights
Donor hearts requiring cardiopulmonary resuscitation (CPR) show no difference in early or late cardiac function after pediatric heart transplantation. This study suggests CPR up to 60 minutes is safe for heart grafts, challenging transplant surgeon reluctance.
Area of Science:
- Cardiology
- Transplantation Surgery
- Pediatric Medicine
Background:
- Transplant surgeons often avoid donor hearts with a history of cardiopulmonary resuscitation (CPR) due to concerns about impaired cardiac function.
- Minimizing contraindications for donor heart utilization presents an opportunity to evaluate the impact of CPR on cardiac function in pediatric heart transplantation.
Purpose of the Study:
- To assess the effects of donor heart arrest and successful cardiopulmonary resuscitation (CPR) on early and late cardiac function in pediatric heart transplant recipients.
- To determine if donor hearts subjected to CPR are safe for transplantation and exhibit comparable function to those not requiring CPR.
Main Methods:
- Retrospective analysis of 140 pediatric heart transplant recipients (birth to 17 years).
- Patients divided into two groups: Group 1 (72) received hearts without CPR, Group 2 (68) received hearts with CPR (mean 18.8 +/- 14.6 minutes, up to 60 minutes).
- Comparison of early cardiac function (ventilator days, inotropic support) and late systolic/diastolic function (echocardiography at 1 week to 2 years) between groups, with similar ischemic times.
Main Results:
- No statistically significant differences were observed in early cardiac function indicators between the CPR and no-CPR groups.
- Echocardiographic analysis revealed no significant differences in systolic or diastolic graft function between the groups at any time point up to 2 years post-transplant.
- Graft function in both groups remained within normal ranges, indicating no long-term detrimental effects from CPR.
Conclusions:
- Donor hearts subjected to cardiopulmonary resuscitation for up to 60 minutes can be safely used in pediatric heart transplantation.
- The study provides evidence against the reluctance to use CPR-affected donor hearts, demonstrating no compromise in early or late cardiac function.
- Successful CPR does not appear to be a contraindication for pediatric heart donor selection, potentially expanding the donor pool.
Abstract:
Transplant surgeons are reluctant to use hearts that have undergone cardiopulmonary resuscitation for cardiac arrest because of the fear of poor early and late cardiac function. A policy of minimizing contraindications to use of donor hearts has led to the unique opportunity of assessing the effects of donor arrest and successful cardiopulmonary resuscitation on early and late cardiac function in pediatric heart transplantation. A number of 140 infants and children undergoing transplantation from birth to 17 years of age were studied retrospectively and divided into two groups on the basis of cardiopulmonary resuscitation status. Group 1 (72 patients) received donor hearts that were not subjected to cardiopulmonary resuscitation; group 2 (68 patients) received donor hearts that had cardiopulmonary resuscitation for a mean of 18.8 +/- 14.6 minutes, the longest period of time being 60 minutes. Mean ischemic times were almost identical in the two groups: 4.43 +/- 2.0 hours (cardiopulmonary resuscitation) versus 4.5 +/- 2.1 hours (no cardiopulmonary resuscitation). Early cardiac function was assessed on the basis of the number of days the recipient was supported by the ventilator, days receiving dopamine, days receiving isoproterenol, and the amount of inotropic agents required after the operation. The groups did not differ. Parameters of systolic function included fractional shortening, posterior wall thickening, and maximum velocity of change in left ventricular posterior wall dimension during systole. Diastolic function was measured on the basis of left ventricular end-diastolic volume, left ventricular mass, and maximum velocity of change in left ventricular posterior wall dimension during diastole. Both systolic and diastolic function were measured and analyzed from M-mode echocardiography at 1 week, 1 month, 6 months, 1 year, and 2 years after the operation. There were no statistically significant differences in graft function between the two groups in any of the echocardiographic parameters studied, even at 2 years. No group differed from ranges of normal. Our results suggest that hearts undergoing cardiopulmonary resuscitation for periods of up to 60 minutes can be used safely without evidence of deterioration of early or late cardiac function.