Cold ischemia > 4 hours increases heart transplantation mortality. An analysis of the Spanish heart transplantation registry


Por: Valero-Masa, MJ, Gonzalez-Vilchez, F, Almenar-Bonet, L, Crespo-Leiro, MG, Manito-Lorite, N, Sobrino-Marquez, JM, Gomez-Bueno, M, Delgado-Jimenez, JF, Perez-Villa, F, Loidi, VB, Arizon-el Prado, JM, Molina, BD, de la Fuente-Galan, L, Ocampo, AP, Bravo, IPG, Aracil, GRJ, Martinez-Selles, M

Publicada: 15 nov 2020 Ahead of Print: 20 jun 2020
Resumen:
Background: Cold ischemia time (CIT) has been associated to heart transplantation (HT) prognosis. However, there is still uncertainty regarding the CIT cutoff value that might have relevant clinical implications. Methods: We analyzed all adults that received a first HT during the period 2008-2018. CIT was defined as the time between the cross-clamp of the donor aorta and the reperfusion of the heart. Primary outcome was 1-month mortality. Results: We included 2629 patients, mean age was 53.3 +/- 12.1 years and 655 (24.9%) were female. Mean CIT was 202 +/- 67 min (minimum 20 min, maximum 600 min). One-month mortality per CIT quartile was 9, 12, 13, and 19%. One-year mortality per CIT quartile was 16, 19, 21, and 28%. CIT was an independent predictor of 1-month mortality, but only in the last quartile of CIT >246 min (odds ratio 2.1, 95% confidence interval 1.49-3.08, p < .001). We found no relevant differences in CIT during the study period. However, the impact of CIT in 1-month and 1-year mortality decreased with time (p value for the distribution of ischemic time by year 0.01), particularly during the last 5 years. Conclusions: Although the impact of CIT in HT prognosis seems to be decreasing in the last years, CIT in the last quartile (>246 min) is associated with 1-month and 1-year mortality. Our findings suggest the need to limit HT with CIT > 246 min or to use different myocardial preservation systems if the expected CIT is >4 h. (C) 2020 Elsevier B.V. All rights reserved.

Filiaciones:
Valero-Masa, MJ:
 Hosp Gen Univ Gregorio Maranon, Dept Cardiol, Calle Doctor Esquerdo,46, Madrid 28007, Spain

 Inst Salud Carlos III, Ctr Invest Biomed Red Enfermedades Cardiovasc CIB, Madrid, Spain

Gonzalez-Vilchez, F:
 Hosp Univ Marques Valdecilla, Dept Cardiol, Santander, Spain

Almenar-Bonet, L:
 Hosp Univ & Politecn La Fe, Dept Cardiol, Valencia, Spain

Crespo-Leiro, MG:
 Inst Salud Carlos III, Ctr Invest Biomed Red Enfermedades Cardiovasc CIB, Madrid, Spain

 Complexo Hosp Univ A Coruna, Dept Cardiol, La Coruna, Spain

Manito-Lorite, N:
 Hosp Univ Bellvitge, Dept Cardiol, Barcelona, Spain

Sobrino-Marquez, JM:
 Hosp Univ Virgen Rocio, Dept Cardiol, Seville, Spain

Gomez-Bueno, M:
 Inst Salud Carlos III, Ctr Invest Biomed Red Enfermedades Cardiovasc CIB, Madrid, Spain

 Hosp Univ Puerta Hierro Majadahonda, Dept Cardiol, Madrid, Spain

Delgado-Jimenez, JF:
 Inst Salud Carlos III, Ctr Invest Biomed Red Enfermedades Cardiovasc CIB, Madrid, Spain

 UCM, Fdn Invest Hosp Univ 12 Octubre, Fac Med, Dept Cardiol, Madrid, Spain

Perez-Villa, F:
 Hosp Clin Univ, Dept Cardiol, Barcelona, Spain

Loidi, VB:
 Hosp Univ Santa Creu & St Pau, Dept Cardiol, Barcelona, Spain

Arizon-el Prado, JM:
 Hosp Univ Reina Sofia, Dept Cardiol, Cordoba, Spain

Molina, BD:
 Hosp Univ Cent Asturias, Dept Cardiol, Oviedo, Spain

de la Fuente-Galan, L:
 Inst Salud Carlos III, Ctr Invest Biomed Red Enfermedades Cardiovasc CIB, Madrid, Spain

 Hosp Clin Univ Valladolid, Dept Cardiol, Valladolid, Spain

Ocampo, AP:
 Hosp Univ Miguel Servet, Dept Cardiol, Zaragoza, Spain

Bravo, IPG:
 Inst Salud Carlos III, Ctr Invest Biomed Red Enfermedades Cardiovasc CIB, Madrid, Spain

 Hosp Univ Virgen Arrixaca, Dept Cardiol, Murcia, Spain

Aracil, GRJ:
 Clin Univ Navarra, Dept Cardiovasc Surg, Pamplona, Spain

Martinez-Selles, M:
 Hosp Gen Univ Gregorio Maranon, Dept Cardiol, Calle Doctor Esquerdo,46, Madrid 28007, Spain

 Inst Salud Carlos III, Ctr Invest Biomed Red Enfermedades Cardiovasc CIB, Madrid, Spain

 Univ Complutense, Univ Europea, Madrid, Spain
ISSN: 01675273
Editorial
ELSEVIER IRELAND LTD, ELSEVIER HOUSE, BROOKVALE PLAZA, EAST PARK SHANNON, CO, CLARE, 00000, IRELAND, Irlanda
Tipo de documento: Article
Volumen: 319 Número:
Páginas: 14-19
WOS Id: 000580586000003
ID de PubMed: 32569699
imagen Green Submitted, Green Accepted

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