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
Green Submitted, Green Accepted
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