276 * DEEP HYPOTHERMIC CIRCULATORY ARREST FOR CONCOMITANT PROCEDURES IN PATIENTS UNDERGOING HEART TRANSPLANTATION

Abstract

Objectives: Outcomes of instituting deep hypothermic circulatory arrest to perform concomitant procedures during heart transplantation in adults are largely undefined. We report our single institutional experience in this surgically complex cohort Methods: From 2004 to 2012, 8 patients undergoing heart transplantation underwent deep hypothermic circulatory arrest for concomitant reconstruction first, followed by donor heart implantation. Records were retrospectively reviewed Results: Seven (87%) patients had ascending aorta plus aortic arch replacement before donor heart implantation, and 1 (13%) patient had Glenn shunt and Waterston shunt takedown with ascending aortic reconstruction. All 8 (100%) cases were redo-sternotomy cases. Circulatory arrest with retrograde cerebral perfusion was employed in 7 (88%) cases, with 1 (12%) patient not receiving any cerebral perfusion during circulatory arrest. Mean times were as follows: circulatory arrest (23 +/- 6 min), bypass (262 +/- 62 min), cross clamp (183 +/- 47 min). Mean allograft ischaemia time was 228 +/- 86 min. In-hospital/30-day mortality was 12% (n = 1), due to primary graft dysfunction. Stroke and paralysis rates were zero. Four patients (50%) had acute renal insufficiency, and 2 patients (25%) required temporary dialysis. Mean length of stay was 34 +/- 28 days. Mean follow-up was 4.8 +/- 3.8 years. One-year mortality was 12% (n = 1), and 6 patients (75%) are alive over a mean follow-up of 4.8 +/- 3.8 years. One patient died 2 years post-transplant from pneumonia. Echocardiographic function of the donor heart has remained normal in these 6 patients Conclusion: Concomitant procedures requiring deep hypothermic circulatory arrest during heart transplantation can be safely performed without compromising patient survival and donor allograft function over mid-term follow-up