AUTHOR=Tevaearai Stahel Hendrik T. , Unger Darja , Schmidli Juerg , Gahl Brigitta , Englberger Lars , Kadner Alexander , Eberle Balthasar , Mohacsi Paul , Carrel Thierry P. 

TITLE=Supplemental Cardioplegia Immediately before Graft Implantation may Improve Early Post-Transplantation Outcome

JOURNAL=Frontiers in Surgery

VOLUME=1

YEAR=2014

URL=https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2014.00046

DOI=10.3389/fsurg.2014.00046

ISSN=2296-875X

ABSTRACT=<p><bold>Background:</bold> Preservation of cardiac grafts for transplantation is not standardized and most centers use a single administration of crystalloid solution at the time of harvesting. We investigated possible benefits of an additional dose of cardioplegia dispensed immediately before implantation.</p><p><bold>Methods:</bold> Consecutive adult cardiac transplantations (2005–2012) were reviewed. Hearts were harvested following a standard protocol (Celsior 2L, 4–8°C). In 2008, 100 ml crystalloid cardioplegic solution was added and administered immediately before implantation. Univariate and logistic regression analyses were used to investigate risk factors for post-operative graft failure and mid-term outcome.</p><p><bold>Results:</bold> A total of 81 patients, 44 standard (“Cardio<sup>−</sup>”) vs. 37 with additional cardioplegia (“Cardio<sup>+</sup>”) were analyzed. Recipients and donors were comparable in both groups. Cardio<sup>+</sup> patients demonstrated a reduced need for defibrillation (24 vs. 48%, <italic>p</italic> = 0.03), post-operative ratio of CK-MB/CK (10.1 ± 3.9 vs. 13.3 ± 4.2%, <italic>p</italic> = 0.001), intubation time (2.0 ± 1.6 vs. 7.2 ± 11.5 days, <italic>p</italic> = 0.05), and ICU stay (3.9 ± 2.1 vs. 8.5 ± 7.8 days, <italic>p</italic> = 0.001). Actuarial survival was reduced when graft ischemic time was &gt;180 min in Cardio<sup>−</sup> but not in Cardio<sup>+</sup> patients (<italic>p</italic> = 0.033). Organ ischemic time &gt;180 min (OR: 5.48, CI: 1.08–27.75), donor female gender (OR: 5.84, CI: 1.13–33.01), and recipient/donor age &gt;60 (OR: 6.33, CI: 0.86–46.75), but not the additional cardioplegia or the observation period appeared independent predictors of post-operative acute graft failure.</p><p><bold>Conclusion:</bold> An additional dose of cardioplegia administered immediately before implantation may be a simple way to improve early and late outcome of cardiac transplantation, especially in situations of prolonged graft ischemia. A large, ideally multicentric, randomized study is desirable to verify this preliminary observation.</p>