Heart Transplantation from Donors with Left Ventricular Systolic Dysfunction

Vitaly Poptsov, Vyachesla Zacharevitch, Ekatherina Spirina, Anastasiya Dogonasheva , Elnur Aliev, Vitaly Pchelnikov, Sergey Masutin, Vladislav Voronkov, Stanislav Ustin, Valeriy Hatutsky

Federal State Budgetary Institution “Academician V.I.Shumakov Federal Research Center of Transplantology and Artificial Organs”, Ministry of Health of the Russian Federation, Moscow, Russian Federation, Moscow, Russia

Date, time and location: 2018.05.25 15:30, Exhibition area, 1st Floor. Zone – A

Abstract

Obgestive. Some transplant centers have successful experience of heart transplantation (HT) from donors with low left ventricle ejection fraction (LVEF).

Purpose of study was evaluated of early outcomes of HT performed from donors with LVEF < 50%.

Materials and methods. The study included 36 (29 men and 7 women, age 20 to 63 (45.5 ±12.5) years) recipients who received cardiac allograft from donors with LVEF ≤ 50%. The urgency of HT was 1A-B (n =14) and 2 status (n=22) UNOS. 10 (27,8%) patients needed peripheral VA ECMO.

Results. Heart donors (28 men and 8 women, 22 to 62 (44.1±10.5) years) were the traumatic (n=23) and non-traumatic (n=13) brain damage. Maximal inotropic support was norepinephrine 550±142 ng/kg /min (n=23) and dopamine 6.1±3.5μg/kg/min (n=6). Laboratory parameters of the heart donor blood: Hb 11.8±0.8 g/l, total protein 60±21 g/l, Na⁺ 148±8 mmol/l, troponin I 0.3±0.2 ng/ml, CK-MB 98 ± 18 U/l. ECG of the donor’s heart: right ventricle 2.7±0.2 cm, LVEDV 134±9 ml, LVEF 22-49 (41.4±4.6) %, LV wall thickness 1.3±0.3 cm, diffuse LV hypokinesis (n=33), regional dyskinesis (n=3). Ischemic time was 159 ± 11 min. 31 (86.1%) had acceptable cardiac allograft function. LVEF≥60% was registered at 3.8 ± 0.6 days after HT. Primary graft failure treated by MCS (VAECMO (n=5)) was in 5 (13.9%). ICU stay was 7.8±1.4 days. 33 (91.3%) recipients were discharged at home.

Conclusions. Own experience demonstrates the satisfactory results of HT from donors with LVEF≤50%. In more cases LV systolic function of cardiac allograft quickly normalized in early period after HT.