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Myocardial preservation using HTK solution for heart transplantation. A multicenter study
H Reichenspurner1, C Russ, P Uberfuhr
1Department of Cardiac Surgery, University of Munich-Grosshadern, Germany.
Insights
Bretschneider HTK solution offers good myocardial preservation for heart transplantation. However, prolonged ischemic times significantly increase acute graft failure and early mortality, underscoring the importance of timely organ reperfusion.
Area of Science:
- Cardiology
- Transplantation Medicine
- Surgical Research
Background:
- Bretschneider HTK solution is a widely used agent for myocardial preservation during heart transplantation.
- Optimizing organ preservation is critical for successful heart transplant outcomes.
Purpose of the Study:
- To evaluate the protective effect of Bretschneider HTK solution in heart transplantation.
- To identify factors influencing graft survival and patient mortality in heart transplant recipients.
Main Methods:
- A retrospective study involving 600 heart transplantations (1981-1991) across five centers.
- Data collected included donor/recipient factors, immunosuppression, and organ function.
- Statistical analysis using the chi2-test to correlate ischemic time and perfusion volume with outcomes.
Main Results:
- Average ischemic time was 160 minutes (range: 75-304 min).
- 4.2% immediate graft failure and 11.8% failure within 30 days were observed.
- Increased ischemic time (P=0.01) and perfusion volume < 1500 ml correlated with higher early graft failure.
Conclusions:
- Bretschneider HTK solution provides good results for myocardial preservation in heart transplantation when ischemic time is under 4 hours.
- Minimizing ischemic time is crucial for reducing acute graft failure and early mortality.
- Further research is needed to explore the impact of increased perfusion volume on extending ischemic times.
Abstract:
Bretschneider HTK solution is commonly used for myocardial preservation. In order to evaluate its protective effect for heart transplantation, a retrospective study was initiated in cooperation with Eurotransplant and five heart transplant centers. Seventy-six female and 524 male patients who underwent cardiac transplantations between 1981 and 1991 were included in this study. Using standardized questionnaires, donor and recipient laboratory data, immunosuppressive therapy and the preoperative, intraoperative and postoperative organ function were documented. The average ischemic time of the donor hearts was 160 min, ranging from 75 min-304 min. Immediate postoperative graft failure was observed in 25 transplantations (4.2%). Within the first 30 days 71 organs (11.8%) failed. Using the chi2-test, a statistically significant increase of acute graft failure and early mortality was evident when they were correlated with the length of ischemic time (P = 0.01). In addition, a higher incidence of early graft failure was observed when the perfusion volume was less than 1500 ml. The 1- and 5-year survival rates were 72% and 63%, respectively. Organ preservation with HTK shows good results as long as the ischemic time does not exceed 4 h. The possibility that an increased perfusion volume allows longer ischemic times cannot be excluded with this study.