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Impact of implantation time on early function of cardiac transplant
Author(s) -
Kuzemchak Marie D.,
Foley Neal M.,
Colazo Juan M.,
Rahaman Zakiur M.,
Danter Matthew R.,
Balsara Keki R.,
Schlendorf Kelly H.,
Shah Ashish S.
Publication year - 2021
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/jocs.15214
Subject(s) - medicine , perioperative , univariate analysis , intensive care unit , cardiology , subgroup analysis , multivariate analysis , post hoc analysis , ischemia , retrospective cohort study , surgery , confidence interval
Background Data on out‐of‐ice implantation ischemia in heart transplant are scarce. We examined implantation time's impact on allograft dysfunction. Methods We conducted a single‐site retrospective review of all primary adult heart transplants from June 2012 to August 2019 for implantation warm ischemic time (WIT), defined as first atrial stitch to aortic crossclamp removal. Univariate regression was used to assess the relationship of perioperative variables to primary graft dysfunction (PGD) and to pulmonary artery pulsatility index (PAPi) at postoperative hour 24. A threshold of p < .10 was set for the inclusion of covariates in multivariate regression. Secondary analyses evaluated for consistency among alternative criteria for allograft dysfunction. A post hoc subgroup analysis examined WIT effect in prolonged total ischemia of 240 min or longer. Results Complete data were available for 201 patients. Baseline characteristics were similar between patients who did and did not have WIT documented. In univariate analysis, female gender, longer total ischemic time (TIT), longer bypass time, greater blood transfusions, and pretransplant intensive care unit (ICU) care were associated with PGD, whereas longer bypass time was associated with worse PAPi and pretransplant ICU care was associated with better PAPi. In multivariate analysis, longer bypass time predicted PGD, and worse PAPi and preoperative ICU admission predicted PGD and better PAPi. Results did not differ in secondary or subgroup analyses. Conclusions This study is one of few examining the functional impact of cardiac implantation ischemia. Results suggest allograft implantation time alone may not impact postoperative graft function, which was driven by intraoperative bypass duration and by preoperative ICU care, instead.