Korean J Transplant.  2022 Nov;36(Supple 1):S206. 10.4285/ATW2022.F-3413.

Clinical outcomes of controlled rewarming technique in heart transplantation: a single-center experience

Affiliations
  • 1Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

Abstract

Background
Orthotopic heart transplantation remains the final method of treatment in end-stage heart failure. In studies to minimize ischemia-reperfusion injury, sudden changes in temperature of the graft has been proposed as a crucial factor, which then led to the concept of controlled rewarming in organ transplantation. In this regard, we have adapted a reperfusion technique protocol in which the harvested graft is perfused with blood cardioplegia that starts at 10 and slowly raised to 26 in 8 minutes, immediately after anastomosing the left atrium (LA) and aorta.
Methods
A retrospective study was conducted using registry database, we identified 23 consecutive patients who received heart transplantation using the controlled rewarming technique between October 2021 and July 2022. The primary outcomes were 30-day mortality or in-hospital mortality and primary graft dysfunction (PGD) as defined by the ISHLT. The secondary outcomes were other surgical complications including bleeding, prolonged ventilation, intensive care unit (ICU) days, acute re-nal failure requiring CRRT, and cardiac enzyme levels.
Results
We identified 23 consecutive cases of orthotopic only-heart transplantation. There were 12 males and 11 females, with median age of 61 (range, 38–71). Twelve patients were under mechanical circulatory support. The median follow-up was 104 days (range, 38–256). As for operative profiles, median total ischemic time 137 minutes (range, 98–282), warm ischemic time 38 minutes (range, 31–53), anastomosis time 55 minutes (range, 41–73), cardiopulmonary bypass time (CPB) 151 minutes (range, 110–250). There were three 30-day mortalities due to sepsis. There were two cases of severe LV-PGD that required ECMO (V-A) insertion. There was one case of need for veno-venous ECMO due to severe pulmonary dysfunction.
Conclusions
A rather novel method at our center showed outcomes that are comparable to high-quality centers. Although a larger cohort is needed to show its statistical effectiveness, we believe this is an efficient, reproducible method.

Full Text Links
  • KJT
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr