180 min in Cardio(-) but not in Cardio(+) patients (p = 0.033). Organ ischemic time >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 >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.CONCLUSION: 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." />
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Tevaearai Stahel HT, Unger D, Schmidli J, et al. Supplemental Cardioplegia Immediately before Graft Implantation may Improve Early Post-Transplantation Outcome. Front Surg. 2014;1:46doi: 10.3389/fsurg.2014.00046.
Tevaearai Stahel, H. T., Unger, D., Schmidli, J., Gahl, B., Englberger, L., Kadner, A., Eberle, B., Mohacsi, P., & Carrel, T. P. (2014). Supplemental Cardioplegia Immediately before Graft Implantation may Improve Early Post-Transplantation Outcome. Frontiers in surgery, 146. https://doi.org/10.3389/fsurg.2014.00046
Tevaearai Stahel, Hendrik T, et al. "Supplemental Cardioplegia Immediately before Graft Implantation may Improve Early Post-Transplantation Outcome." Frontiers in surgery vol. 1 (2014): 46. doi: https://doi.org/10.3389/fsurg.2014.00046
Tevaearai Stahel HT, Unger D, Schmidli J, Gahl B, Englberger L, Kadner A, Eberle B, Mohacsi P, Carrel TP. Supplemental Cardioplegia Immediately before Graft Implantation may Improve Early Post-Transplantation Outcome. Front Surg. 2014 Nov 28;1:46. doi: 10.3389/fsurg.2014.00046. eCollection 2014. PMID: 25593970; PMCID: PMC4286961.
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Front Surg. 2014 Nov 28;1:46. doi: 10.3389/fsurg.2014.00046. eCollection 2014.

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

Frontiers in surgery

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

Affiliations

  1. Clinic for Cardiovascular Surgery, Bern University Hospital (Inselspital), University of Bern , Bern , Switzerland.
  2. Department of Anaesthesiology and Pain Medicine, Bern University Hospital (Inselspital), University of Bern , Bern , Switzerland.
  3. Department of Cardiology, Bern University Hospital (Inselspital), University of Bern , Bern , Switzerland.

PMID: 25593970 PMCID: PMC4286961 DOI: 10.3389/fsurg.2014.00046

Abstract

BACKGROUND: 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.

METHODS: 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.

RESULTS: A total of 81 patients, 44 standard ("Cardio(-)") vs. 37 with additional cardioplegia ("Cardio(+)") were analyzed. Recipients and donors were comparable in both groups. Cardio(+) patients demonstrated a reduced need for defibrillation (24 vs. 48%, p = 0.03), post-operative ratio of CK-MB/CK (10.1 ± 3.9 vs. 13.3 ± 4.2%, p = 0.001), intubation time (2.0 ± 1.6 vs. 7.2 ± 11.5 days, p = 0.05), and ICU stay (3.9 ± 2.1 vs. 8.5 ± 7.8 days, p = 0.001). Actuarial survival was reduced when graft ischemic time was >180 min in Cardio(-) but not in Cardio(+) patients (p = 0.033). Organ ischemic time >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 >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.

CONCLUSION: 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.

Keywords: cardiac surgery outcome; cardiac transplantation; cardioplegia; organ

References

  1. Transplantation. 1997 Jan 27;63(2):262-9 - PubMed
  2. JAMA. 2009 Jun 17;301(23):2445-52 - PubMed
  3. J Heart Lung Transplant. 1999 Apr;18(4):310-9 - PubMed
  4. Ann Thorac Surg. 2012 Mar;93(3):699-704 - PubMed
  5. Eur J Cardiothorac Surg. 2003 Jun;23(6):898-906 - PubMed
  6. Transpl Int. 2013 Mar;26(3):267-72 - PubMed
  7. Transplantation. 2007 May 27;83(10):1289-98 - PubMed
  8. Transplantation. 2009 Jan 27;87(2):243-8 - PubMed
  9. J Heart Lung Transplant. 2013 Oct;32(10):951-64 - PubMed
  10. PLoS One. 2013 Sep 06;8(9):e74241 - PubMed
  11. Eur J Cardiothorac Surg. 2012 Apr;41(4):e53-5 - PubMed
  12. Thorac Cardiovasc Surg. 2012 Jul;60(5):360-2 - PubMed
  13. J Heart Lung Transplant. 1992 Sep-Oct;11(5):986-93 - PubMed
  14. Transplant Proc. 2012 May;44(4):886-9 - PubMed
  15. Eur J Cardiothorac Surg. 2012 Apr;41(4):e48-52; discussion e52-3 - PubMed
  16. Eur J Cardiothorac Surg. 2011 Oct;40(4):962-9 - PubMed
  17. Ann Thorac Surg. 1999 Oct;68(4):1242-6 - PubMed

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