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5-year Outcomes Of Orthotopic Heart Transplantation By A Novel Implantation Perfusion Technique That Eliminates Warm Ischaemic Time (wit)
David Varghese1, Sylvia Yew
2, Amy Tang
2, Prashant Mohite
1, Karim Morcos
1, Yasser Hegazy
1, Phil McCall
1, Philip Curry
1;
1Golden Jubilee National Hospital, Glasgow, United Kingdom,
2University of Glasgow, Glasgow, United Kingdom
Introduction Recipient WIT is measured by the organ implantation period, which starts from the removal of the organ from cold preservation solution until its reperfusion with the recipient's warm blood. During this WIT, the donor heart is exposed to warmer temperatures during implant surgery that in-turn increase its metabolic rate, enzyme activity and the associated formation of oxygen-free radicals so accelerate the effect of ischaemia on the donor heart. Our novel implantation perfusion technique, only the left atrial and ascending aortic anastomoses were performed with the aortic cross-clamp on, with our perfusion technique with cold blood antegrade cardioplegia followed by continuous aortic cold blood perfusion during the heart implantation procedure until the release of the recipient aortic cross-clamp and reperfusion with warm blood then the remaining anastomoses were completed during reperfusion. The aim of this study was to see how the elimination of WIT with our novel implantation perfusion technique and the effects on the long-term results of heart transplantation. Methods The database was interrogated for demographic details, donor, and recipient characteristics alongside post-operative outcomes from 2016 to 2018 to provide a minimum 5 year follow up. Data was analysed using Unistat. Results are expressed as median (inter-quartile range - IQR) and n (%). Results: There were 34 patients in total, 25 (74%) males, aged 48 (IQR 18) mostly blood group O 15 (45%), and dilated cardiomyopathy was the most common aetiology 14 (45%). Nine (28%) needed pre-operative mechanical support. Donor age was 35 (IQR 15), predominantly male 19 (63%) and left ventricular ejection fraction of 57% (8). The total ischaemic time was 179 minutes (IQR 92). Nine patients (26%) had primary graft dysfunction (PGD) vs 39% UK average, p = 0.03. Two patients (6%) had severe PGD needing ECMO. The median survival length is 6 years (2). Log rank analysis of survival length and severe PGD was p=0.10. Overall one year survival was 30 (88%) vs 85% and 5-year survival was 26 (76%) vs 71, p>0.05 vs UK data respectively. Discussion: Our novel implantation perfusion technique with continuous antegrade aortic cold blood perfusion and modified early aortic cross-clamp release is superior to the conventional technique in reducing PGD. Though not statistically significant there is a trend towards greater long term survival post heart transplant as a result of the elimination of the donor heart WIT and reduction of PGD. This technique is easy reproducible and can be reliably applied to decrease overall allograft ischaemic time and eliminate warm ischaemic time.
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