[en] [en] OBJECTIVES: The choice of the cardiac preservation solution for myocardial protection at time of heart procurement remains controversial and uncertainties persist regarding its effect on the early and midterm heart transplantation (HTx) outcomes. We retrospectively compared our adult HTx performed with 2 different solutions, in terms of hospital mortality, mid-term survival, inotropic score, primary graft dysfunction and rejection score.
METHODS: From January 2009 to December 2020, 154 consecutive HTx of adult patients, followed up in pre- and post-transplantation by 2 different tertiary centres, were performed at the University Hospital of Lausanne, Switzerland. From 2009 to 2015, the cardiac preservation solution used was exclusively St-Thomas, whereafter an institutional decision was made to use HTK-Custodiol only. Patients were classified in 2 groups accordingly.
RESULTS: There were 75 patients in the St-Thomas group and 79 patients in the HTK-Custodiol group. The 2 groups were comparable in terms of preoperative and intraoperative characteristics. Postoperatively, compared to the St-Thomas group, the Custodiol group patients showed significantly lower inotropic scores [median (interquartile range): 35.7 (17.5-60.2) vs 71.8 (31.8-127), P < 0.001], rejection scores [0.08 (0.0-0.25) vs 0.14 (0.05-0.5), P = 0.036] and 30-day mortality rate (2.5% vs 14.7%, P = 0.007) even after adjusting for potential confounders. Microscopic analysis of the endomyocardial biopsies also showed less specific histological features of subendothelial ischaemia (3.8% vs 17.3%, P = 0.006). There was no difference in primary graft dysfunction requiring postoperative extracorporeal membrane oxygenation. The use of HTK-Custodiol solution significantly improved midterm survival (Custodiol versus St-Thomas: hazard ratio = 0.20, 95% confidence interval: 0.069-0.60, P = 0.004).
CONCLUSIONS: This retrospective study comparing St-Thomas solution and HTK-Custodiol as myocardial protection during heart procurement showed that Custodiol improves outcomes after HTx, including postoperative inotropic score, rejection score, 30-day mortality and midterm survival.
Disciplines :
Cardiovascular & respiratory systems
Author, co-author :
Dulguerov, Filip ; Department of Cardiac Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
Abdurashidowa, Tamila ; Department of Cardiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
Christophel-Plathier, Emeline ; Department of Anesthesiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
Ion, Lucian; Department of Cardiac Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
Gunga, Ziyad ; Department of Cardiac Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
Rancati, Valentina ; Department of Cardiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
Yerly, Patrick ; Department of Cardiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
Tozzi, Piergiorgio ; Department of Cardiac Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
Albert, Adelin ; Université de Liège - ULiège > Département des sciences de la santé publique
Ltaief, Zied; Department of Intensive Care, Lausanne University Hospital (CHUV), Lausanne, Switzerland
Rotman, Samuel ; Department of Pathology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
Meyer, Philippe ; Department of Medical Specialties, University Hospitals of Geneva (HUG), Geneva, Switzerland
Lefol, Karl; Department of Cardiology, Organ Transplant Centre, Lausanne University Hospital (CHUV), Lausanne, Switzerland
Hullin, Roger ; Department of Cardiology, Lausanne University Hospital (CHUV), Lausanne, Switzerland
Kirsch, Matthias ; Department of Cardiac Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland
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