Stretching the Cardiac Donor Ischemic Time to Beyond Six Hours: What�s the Impact?

Rahul Chandola, Masato Mutsuga, Colleen Norris and Shaohua Wang

Division of Cardiovascular Surgery, University of Alberta Hospital, Canada
Department of Cardiac Surgery, Nagoya University, Japan

^*Correspondance to: Rahul Chandola 

 PDF  Full Text DOI: 10.25107/2474-1647.1578

Abstract

Objective: The evidence evaluating the impact of prolonged ischemia time, in particular beyond 360 min in the adult population, on the heart transplant outcomes is limited. We sought to determine if prolonged ischemic times beyond 360 min has any impact on the postoperative outcomes and short, midterm and long term survival of heart transplants at University of Alberta.Material and
Method: Data was collected from the Alberta Provincial Project for Outcome Assessment in Coronary Heart Disease (APPROACH) database. This database is a prospective data collection registry that collects real-time data, from three hospital sites, beginning at the patient’s referral for cardiac catheterization. Data is entered into the APPROACH registry along the patient’s clinical trajectory. The APPROACH database is a mandatory registry for all patients in all hospitals that provide cardiac catheterization, coronary revascularization and cardiac surgery in Alberta.Results: Univariate analysis, identified a significant difference between PIT (prolonged ischemic time) and MIT (moderate ischemic time) groups in 30 day (23.7% and 8.6%, p< 0.001) and 6 month mortality (24.7% and 9.9% p< 0.001). Long term survival between groups was also significantly different (p=0.04) between both groups. Though univariate analysis did show significant mortality differences, when we controlled both the groups for the variables such as prior PCI, pretransplant dialysis, pretransplant liver dysfunction, donor age and duration of cardiopulmonary bypass, there were no significant differences in survival outcomes between the two groups (hazard ratio 1.19).Conclusion: With the current techniques of myocardial preservation, modified reperfusion and the detailed evaluation of recipient and donor factors on a case by case basis, donor hearts with ischemia time greater than 6 h provide comparable postoperative outcomes and short, intermediate and long term survival results. The prolonged ischemic times, in itself, should not be a contraindication for transplant.

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Cite the article

Chandola R, Mutsuga M, Norris C, Wang S. Stretching the Cardiac Donor Ischemic Time to Beyond Six Hours: What�s the Impact? Clin Surg. 2017; 2: 1578.