USE OF DONOR HEARTS WITH MARGINAL SYSTOLIC FUNCTION FOR TRANSPLANTATION: A CASE MATCHED CLINICAL STUDY
CCC ePoster Library. Vu M. 10/26/19; 280531; 296
Dr. Minh Quan Vu
Dr. Minh Quan Vu
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Abstract
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BACKGROUND: The left ventricular ejection fraction (LEVF) is a major suitability criterion for donor heart selection. When the LVEF is found to be lower than 45%, a standardised resuscitation protocol is instituted followed by a reassessment. In case of LVEF normalisation, the hearts can then be used for transplantation. The goal of the present study is to compare the outcomes of cardiac transplantation in recipients receiving recovered heart to ones whose donors had initial normal function.

METHODS AND RESULTS: Between 2016 and 2018, 12 potential donors with initially significant left ventricular dysfunction underwent the recovery protocol and became suitable for transplantation in our institution. The patients receiving those hearts were matched for age, body weight and gender with those receiving hearts with initial normal LVEF. Twelve recovered donors, aged 32 ± 15 years, showed a LVEF of 38 ± 8% at the initial echocardiography after pronunciation of brain death. Following treatment, the LVEF improved to 55 ± 9%. The twelve donors of the control group were 34 ± 11 years of age and had a LVEF of 59 ± 5% at the initial echocardiographic evaluation. Recipients' age in the recovered and control group was 44±14 and 47±18 years respectively (p=0.65). LVEF was 47±13% vs 52±7% postoperatively (p=0.3) and 64±3% vs 59±2% one year after surgery (p=0.09). One-year mortality was similar; one death in each group (1/12, 8%) was both due to primary graft failure. The length of hospitalisation was 21 ± 31 vs 12 ±16 days (p=0,73). The incidence of right ventricular dysfunction did not differ significantly between the two groups, and gender with those receiving hearts with initial normal LVEF.

CONCLUSION: Hearts from potential donors with initially significant left ventricular dysfunction following neurological death that normalize their LVEF with hemodynamic optimization and hormonal resuscitation can become suitable for transplantation. Recipients of these recovered hearts have similar clinical outcomes after cardiac transplantation than those receiving standard donors. Hearts that had early complete recovery of dysfunctional maintain a normal LVEF after 1 year.
BACKGROUND: The left ventricular ejection fraction (LEVF) is a major suitability criterion for donor heart selection. When the LVEF is found to be lower than 45%, a standardised resuscitation protocol is instituted followed by a reassessment. In case of LVEF normalisation, the hearts can then be used for transplantation. The goal of the present study is to compare the outcomes of cardiac transplantation in recipients receiving recovered heart to ones whose donors had initial normal function.

METHODS AND RESULTS: Between 2016 and 2018, 12 potential donors with initially significant left ventricular dysfunction underwent the recovery protocol and became suitable for transplantation in our institution. The patients receiving those hearts were matched for age, body weight and gender with those receiving hearts with initial normal LVEF. Twelve recovered donors, aged 32 ± 15 years, showed a LVEF of 38 ± 8% at the initial echocardiography after pronunciation of brain death. Following treatment, the LVEF improved to 55 ± 9%. The twelve donors of the control group were 34 ± 11 years of age and had a LVEF of 59 ± 5% at the initial echocardiographic evaluation. Recipients' age in the recovered and control group was 44±14 and 47±18 years respectively (p=0.65). LVEF was 47±13% vs 52±7% postoperatively (p=0.3) and 64±3% vs 59±2% one year after surgery (p=0.09). One-year mortality was similar; one death in each group (1/12, 8%) was both due to primary graft failure. The length of hospitalisation was 21 ± 31 vs 12 ±16 days (p=0,73). The incidence of right ventricular dysfunction did not differ significantly between the two groups, and gender with those receiving hearts with initial normal LVEF.

CONCLUSION: Hearts from potential donors with initially significant left ventricular dysfunction following neurological death that normalize their LVEF with hemodynamic optimization and hormonal resuscitation can become suitable for transplantation. Recipients of these recovered hearts have similar clinical outcomes after cardiac transplantation than those receiving standard donors. Hearts that had early complete recovery of dysfunctional maintain a normal LVEF after 1 year.
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