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Utilization of pediatric donors salvaged by cardiopulmonary resuscitation
M Kawauchi1, S R Gundry, J A de Begoña
1Department of Surgery, School of Medicine, Loma Linda University Medical Center, Calif. 92354.
Insights
Pediatric heart transplants using donors with extended cardiopulmonary resuscitation (CPR) history are safe and effective. Despite slightly elevated myosin levels, these donor hearts show good hemodynamic recovery and cardiac function post-transplant.
Area of Science:
- Cardiology
- Transplantation Medicine
- Pediatric Surgery
Background:
- Infant donors with extended cardiopulmonary resuscitation (CPR) history are a potential source for heart transplantation.
- Assessing the viability and safety of these donor hearts is crucial for expanding the donor pool.
Purpose of the Study:
- To investigate the efficacy and safety of using infant donors with extended CPR history for heart transplantation.
- To compare myocardial damage and cardiac function between donors with and without extended CPR history.
Main Methods:
- Retrospective analysis of heart transplantations comparing two groups of infant donors: minimal CPR (<10 min) and extended CPR (35-125 min).
- Evaluation of peak myosin levels and cardiac function (systolic and diastolic) in the first week post-transplantation.
- Hemodynamic assessment in the early postoperative period.
Main Results:
- No significant differences in donor/recipient age, ischemic time, or early cardiac function between groups.
- Donors with extended CPR history showed significantly higher peak myosin levels, indicating minimal myocardial damage.
- All donor hearts exhibited normal early postoperative hemodynamics.
Conclusions:
- Heart transplantation using pediatric donor grafts with prolonged CPR history is safe and efficacious.
- Despite increased myosin efflux, these hearts demonstrate adequate hemodynamic recovery and function.
Abstract:
The efficacy of using infant donors with an extended cardiopulmonary resuscitation (CPR) history was investigated. Eight heart transplantations with donors who had no or minimal (less than 10 minutes) history of CPR (group A) and seven heart transplantations with donors with extended CPR history (35 to 125 minutes; mean, 59 minutes; group B) were compared for peak myosin levels after transplantation, and systolic and diastolic cardiac function in the first week after transplantation. All donor hearts had normal hemodynamics in the early postoperative period. No significant differences were found between the groups with regard to age of donors, age of recipients, donor heart ischemic time, and cardiac function in the first week after transplantation. In group B, peak myosin levels were 1.4, 4.6, 7.0, 11.3, 14.8, 20.2, and 21.3 ng/ml. These values were significantly (p < 0.05) higher than those in group A but represented only minimal myocardial damage when compared with the values in previous myocardial infarction studies. Although donors with a history of protracted CPR had higher efflux of myosin light chains perioperatively, hemodynamic recovery suggests that use of pediatric donor heart grafts after prolonged CPR is safe and efficacious.