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, 4-8degreeC). In 2008, 100ml 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+/-11.5days, p=0.05), and ICU stay (3.9+/-2.1 vs. 8.5+/-7.8days, p=0.001). Actuarial survival was reduced when graft ischemic time was >180min in Cardio(-) but not in Cardio(+) patients (p=0.033). Organ ischemic time >180min (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.
Tevaearai Stahel, H. T., Unger, D., Schmidli, J., Gahl, B., Englberger, L., Kadner, A., … Carrel, T. P. (2014). Supplemental Cardioplegia Immediately before Graft Implantation may Improve Early Post-Transplantation Outcome. Frontiers in Surgery, 1. https://doi.org/10.3389/fsurg.2014.00046