1
|
Sicim H, Tam WSV, Tang PC. Primary graft dysfunction in heart transplantation: the challenge to survival. J Cardiothorac Surg 2024; 19:313. [PMID: 38824545 PMCID: PMC11143673 DOI: 10.1186/s13019-024-02816-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 05/25/2024] [Indexed: 06/03/2024] Open
Abstract
Primary graft dysfunction (PGD) is a life-threatening clinical condition with a high mortality rate, presenting as left, right, or biventricular dysfunction within the initial 24 h following heart transplantation, in the absence of a discernible secondary cause. Given its intricate nature, definitive definition and diagnosis of PGD continues to pose a challenge. The pathophysiology of PGD encompasses numerous underlying mechanisms, some of which remain to be elucidated, including factors like myocardial damage, the release of proinflammatory mediators, and the occurrence of ischemia-reperfusion injury. The dynamic characteristics of both donors and recipients, coupled with the inclination towards marginal lists containing more risk factors, together contribute to the increased incidence of PGD. The augmentation of therapeutic strategies involving mechanical circulatory support accelerates myocardial recovery, thereby significantly contributing to survival. Nonetheless, a universally accepted treatment algorithm for the swift management of this clinical condition, which necessitates immediate intervention upon diagnosis, remains absent. This paper aims to review the existing literature and shed light on how diagnosis, pathophysiology, risk factors, treatment, and perioperative management affect the outcome of PGD.
Collapse
Affiliation(s)
- Hüseyin Sicim
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA.
| | - Wing Sum Vincy Tam
- School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
| | - Paul C Tang
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
2
|
McGiffin DC, Kure CE, Macdonald PS, Jansz PC, Emmanuel S, Marasco SF, Doi A, Merry C, Larbalestier R, Shah A, Geldenhuys A, Sibal AK, Wasywich CA, Mathew J, Paul E, Cheshire C, Leet A, Hare JL, Graham S, Fraser JF, Kaye DM. Hypothermic oxygenated perfusion (HOPE) safely and effectively extends acceptable donor heart preservation times: Results of the Australian and New Zealand trial. J Heart Lung Transplant 2024; 43:485-495. [PMID: 37918701 DOI: 10.1016/j.healun.2023.10.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/08/2023] [Accepted: 10/25/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Cold static storage preservation of donor hearts for periods longer than 4 hours increases the risk of primary graft dysfunction (PGD). The aim of the study was to determine if hypothermic oxygenated perfusion (HOPE) could safely prolong the preservation time of donor hearts. METHODS We conducted a nonrandomized, single arm, multicenter investigation of the effect of HOPE using the XVIVO Heart Preservation System on donor hearts with a projected preservation time of 6 to 8 hours on 30-day recipient survival and allograft function post-transplant. Each center completed 1 or 2 short preservation time followed by long preservation time cases. PGD was classified as occurring in the first 24 hours after transplantation or secondary graft dysfunction (SGD) occurring at any time with a clearly defined cause. Trial survival was compared with a comparator group based on data from the International Society of Heart and Lung Transplantation (ISHLT) Registry. RESULTS We performed heart transplants using 7 short and 29 long preservation time donor hearts placed on the HOPE system. The mean preservation time for the long preservation time cases was 414 minutes, the longest being 8 hours and 47 minutes. There was 100% survival at 30 days. One long preservation time recipient developed PGD, and 1 developed SGD. One short preservation time patient developed SGD. Thirty day survival was superior to the ISHLT comparator group despite substantially longer preservation times in the trial patients. CONCLUSIONS HOPE provides effective preservation out to preservation times of nearly 9 hours allowing retrieval from remote geographic locations.
Collapse
Affiliation(s)
- David C McGiffin
- Department of Cardiothoracic Surgery and Transplantation, The Alfred, Melbourne, Australia; Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia; Critical Care Research Group, Adult Intensive Care Unit, The Prince Charles Hospital, Brisbane, Australia; University of Queensland, Brisbane, Australia.
| | - Christina E Kure
- Department of Cardiothoracic Surgery and Transplantation, The Alfred, Melbourne, Australia; Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia
| | | | - Paul C Jansz
- Department of Cardiothoracic Surgery, St Vincent's Hospital, Sydney, Australia
| | - Sam Emmanuel
- Department of Cardiothoracic Surgery, St Vincent's Hospital, Sydney, Australia
| | - Silvana F Marasco
- Department of Cardiothoracic Surgery and Transplantation, The Alfred, Melbourne, Australia; Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia
| | - Atsuo Doi
- Department of Cardiothoracic Surgery and Transplantation, The Alfred, Melbourne, Australia
| | - Chris Merry
- Department of Cardiothoracic Surgery and Transplantation, The Alfred, Melbourne, Australia
| | - Robert Larbalestier
- Department of Cardiothoracic Surgery, Fiona Stanley Hospital, Perth, Australia
| | - Amit Shah
- Department of Cardiology, Fiona Stanley Hospital, Perth, Australia
| | - Agneta Geldenhuys
- Department of Cardiothoracic Surgery, Fiona Stanley Hospital, Perth, Australia
| | - Amul K Sibal
- Department of Cardiothoracic Surgery, Auckland City Hospital, Auckland, New Zealand
| | - Cara A Wasywich
- Department of Cardiology, Auckland City Hospital, Auckland, New Zealand
| | - Jacob Mathew
- Department of Cardiology, Royal Children's Hospital, Melbourne, Australia
| | - Eldho Paul
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Angeline Leet
- Department of Cardiology, The Alfred, Melbourne, Australia
| | - James L Hare
- Department of Cardiology, The Alfred, Melbourne, Australia
| | - Sandra Graham
- Department of Cardiology, The Alfred, Melbourne, Australia
| | - John F Fraser
- Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia; Critical Care Research Group, Adult Intensive Care Unit, The Prince Charles Hospital, Brisbane, Australia; University of Queensland, Brisbane, Australia; St Andrews War Memorial Hospital, Brisbane, Australia
| | - David M Kaye
- Department of Surgery, Central Clinical School, Monash University, Melbourne, Australia; Monash-Alfred-Baker Centre for Cardiovascular Research, Monash University, Melbourne, Australia
| |
Collapse
|
3
|
Kaveevorayan P, Tokavanich N, Kittipibul V, Lertsuttimetta T, Singhatanadgige S, Ongcharit P, Sinphurmsukskul S, Ariyachaipanich A, Siwamogsatham S, Thammanatsakul K, Sritangsirikul S, Puwanant S. Primary isolated right ventricular failure after heart transplantation: prevalence, right ventricular characteristics, and outcomes. Sci Rep 2023; 13:394. [PMID: 36624245 PMCID: PMC9829713 DOI: 10.1038/s41598-023-27482-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 01/03/2023] [Indexed: 01/11/2023] Open
Abstract
To determine the prevalence, right ventricular (RV) characteristics, and outcomes of primary isolated RV failure (PI-RVF) after heart transplant (HTX). PI-RVF was defined as (1) the need for mechanical circulatory support post-transplant, or (2) evidence of RVF post-transplant as measured by right atrial pressure (RAP) > 15 mmHg, cardiac index of < 2.0 L/min/m2 or inotrope support for < 72 h, pulmonary capillary wedge pressure < 18 mmHg, and transpulmonary gradient < 15 mmHg with pulmonary systolic pressure < 50 mmHg. PI-RVF can be diagnosed from the first 24-72 h after completion of heart transplantation. A total of 122 consecutive patients who underwent HTX were reviewed. Of these, 11 were excluded because of secondary causes of graft dysfunction (GD). PI-RVF was present in 65 of 111 patients (59%) and 31 (48%) met the criteria for PGD-RV. Severity of patients with PI-RVF included 41(37%) mild, 14 (13%) moderate, and 10 (9%) severe. The median onset of PI-RVF was 14 (0-49) h and RV recovery occurred 5 (3-14) days after HTX. Severe RV failure was a predictor of 30-day mortality (HR 13.2, 95% CI 1.6-124.5%, p < 0.001) and post-transplant dialysis (HR 6.9, 95% CI 2.0-257.4%, p = 0.001). Patients with moderate PI-RVF had a higher rate of 30-day mortality (14% vs. 0%, p = 0.014) and post-operative dialysis (21% vs. 2%, p = 0.016) than those with mild PI-RVF. Among patients with mild and moderate PI-RVF, patients who did not meet the criteria of PGD-RV had worsening BUN/creatinine than those who met the PGD-RV criteria (p < 0.05 for all). PI-RVF was common and can occur after 24 h post-HTX. The median RV recovery time was 5 (2-14) days after HTX. Severe PI-RVF was associated with increased rates of 30-day mortality and post-operative dialysis. Moderate PI-RVF was also associated with post-operative dialysis. A revised definition of PGD-RV may be needed since patients who had adverse outcomes did not meet the criteria of PGD-RV.
Collapse
Affiliation(s)
- Peerapat Kaveevorayan
- grid.7922.e0000 0001 0244 7875Division of Cardiovascular Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Nithi Tokavanich
- grid.7922.e0000 0001 0244 7875Division of Cardiovascular Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Veraprapas Kittipibul
- grid.7922.e0000 0001 0244 7875Division of Cardiovascular Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Thana Lertsuttimetta
- grid.7922.e0000 0001 0244 7875Division of Cardiovascular Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Seri Singhatanadgige
- grid.7922.e0000 0001 0244 7875Division of Cardiothoracic Surgery, Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand ,Cardiac Center, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, 10330 Thailand
| | - Pat Ongcharit
- grid.7922.e0000 0001 0244 7875Division of Cardiothoracic Surgery, Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand ,Cardiac Center, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, 10330 Thailand ,The Excellent Center of Organ Transplantation, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, 10330 Thailand
| | - Supanee Sinphurmsukskul
- The Excellent Center of Organ Transplantation, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, 10330 Thailand
| | - Aekarach Ariyachaipanich
- grid.7922.e0000 0001 0244 7875Division of Cardiovascular Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand ,Cardiac Center, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, 10330 Thailand ,The Excellent Center of Organ Transplantation, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, 10330 Thailand
| | - Sarawut Siwamogsatham
- grid.7922.e0000 0001 0244 7875Faculty of Medicine, Chula Clinical Research Center, Chulalongkorn University, Bangkok, Thailand
| | - Kanokwan Thammanatsakul
- The Excellent Center of Organ Transplantation, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, 10330 Thailand
| | - Supaporn Sritangsirikul
- The Excellent Center of Organ Transplantation, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, 10330 Thailand
| | - Sarinya Puwanant
- Division of Cardiovascular Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand. .,Cardiac Center, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, 10330, Thailand. .,The Excellent Center of Organ Transplantation, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, 10330, Thailand.
| |
Collapse
|