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Abstracts

The Journal of Heart and Lung Transplantation February 2006

D. Marelli,1 S. Silvestry,1 D. Zwas,1 P. Mather,1 S. Rubin,1 R. Choudry,1 A. Dempsey,1 L. Stein,1 J. Diehl,1 A. Feldman,1 1Heart Transplant Program, Thomas Jefferson University Hospital, Philadelphia, PA

271 PRE-TRANPLANT GLUCOSE INTOLERANCE AND NOT DIABETES PREDICTS NON-FATAL MAJOR ADVERSE CARDIAC EVENTS AFTER CARDIAC TRANSPLANTATION S. Smooke,1 S. Dev,2 J.K. Patel,1 J. Kawano,1 N.P. Almeda,1 O.M. Thompson,1 G.W. Wu,1 H. Laks,1 J.A. Kobashigawa,1 1 Medicine, University of California at Los Angeles, Los Angeles, CA; 2Medicine, Northwestern University, Chicago, IL Pre transplant diabetes has been reported as a risk factor for poor outcome after heart transplantation. Glucose intolerance (GI, defined as fasting glucose ⬎100 mg/dl and ⬍126 mg/dl on no diabetic therapy) has been associated with increased inflammation and cardiac events in non-transplant patients. The prevalence of glucose intolerance in pre-transplant patients is not known, nor is its effect on outcome in patients following cardiac transplantation. Methods: We reviewed 455 patients between January 1994 and December 2003 for the presence of pre-transplant glucose intolerance and diabetes (defined as fasting glucose ⬎126 mg/dl x2 or oral and/or insulin treatment). These patients were assessed for posttransplant outcomes of 5-year survival, non-fatal major adverse cardiac events (nf-MACE, defined as acute myocardial infarction, congestive heart failure, percutaneous cardiac intervention, cerebral vascular accident, peripheral vascular disease) and cardiac allograft vasculopathy. Results: The prevalence of pre transplant glucose intolerance and diabetes was 32.6% (GI 6.7%, diabetes 25.9%). Following transplant, the patients with pre-transplant GI had increased development of nf-MACE compared to the control group (p⫽0.0224, Fisher’s Exact Test) but had similar CAV (32.0% vs. 23.7%, p⫽0.3395, Fisher’s Exact Test). Compared to those patients in the control group (without pre-transplant diabetes or GI, 250 patients), there was a numerically lower 5-year survival rate in the pre-transplant GI patients (GI 60.0% vs. control 73.0%, p⫽0.15, log rank). The pre-transplant diabetic group had similar outcomes (NF-MACE, CAV) compared to the control group. Conclusion: Pre transplant glucose intolerance but not pre-transplant diabetes may be a risk factor for nf-MACE after heart transplantation. Further studies into the effects of pre-transplant GI may elucidate the mechanism by which this occurs.

272 MODIFIED INFERIOR VENA CAVA ANASTOMOSIS TO REDUCE TRICUSPID VALVE REGURGITATION AFTER ORTHOTOPIC HEART TRANSPLANTATION

Purpose: Tricuspid valve regurgitation (TR) can be moderate to severe in 15–20% of OHT recipients despite the bicaval technique. Although annuloplasty to reduce TR has been described, it is not widely used. We hypothesized that TR after OHT may be in part due to increased tension on the donor right atrium (RA). We present a technique which may reduce TR by attempting to address this distortion. Methods: The modified technique consists of augmenting the donor right atrial anterior wall with a flap of recipient right atrium that is left attached to the anterior aspect of the inferior vena cava (IVC). An incision in the donor right atrial wall is made from the corresponding aspect of the IVC remnant toward the appendage away from the sino-atrial node. Because one author was using this technique for several years, we reviewed TR in the last follow-up echo of the most recent 6 consecutive recipients who were followed for at least 30 days. All patients were male, 55 ⫹/⫺ 6.3 years. At the last echocardiogram, the mean time since OHT was 92.2 days ⫹/⫺ 61.8 days. TR velocity, jet area, (RA) area, and right atrioventricular annulus (RAV) diameter were measured using 2-D, M-mode, and Doppler color echo. We quantified the TR according to Jet area/RA area*100. TR was scaled as ⬍10% trace (1), 10 –25% mild (2), 26 –50% moderate (3), ⬎50%, severe (4). All studies were interpreted by a single observer. Results: No patient needed permanent pacing. The 30 day survival was 100%. Overall TR was trace to mild. Average TR velocity was 2.68 ⫹/⫺ 0.4 m/s; jet area was 1.61 ⫹/⫺ 1.28 cm2. Average RA area and RAV diameter were 16.6 ⫹/⫺ 2.92 cm2 and 2.78 ⫹/⫺ 0.37 cm. The mean quantified TR was 9.72% ⫹/⫺ 7.74%, and the mean scaled TR was 1.60 ⫹/⫺ 0.55. Conclusions: The described modified inferior vena cava anastomosis offers a safe method that is universally applicable to improve TR after OHT using the bicaval technique. It eliminates ⬎ mild TR without annuloplasty. 273 PREVENTION OF SUBCLINICAL CMV INFECTION REDUCES CARDIAC ALLOGRAFT DISEASE PROGRESSION BY POSITIVELY AFFECTING CORONARY REMODELING L. Potena,1,2 W. Fearon,2 C. Holweg,2 H. Luikart,2 C. Chin,2 J. Cooke,2 D. Lewis,2 E. Mocarski,2 H. Valantine,2 1Cardiovascular Diseases, University of Bologna, Bologna, Italy; 2Cardiovascular Medicine, Stanford University, Stanford, CA Antiviral prophylaxis prevents acute cytomegalovirus (CMV) disease but its effect on subclinical infection and graft outcome is unknown. Here we compared the effect on allograft vasculopathy (CAV) of a longer and more aggressive prophylaxis with the standard 4-weeks ganciclovir-based regimen. 31 consecutive heart transplant (HT) recipients who consented to intracoronary ultrasound evaluation at 1 and 12 months after HT were prospectively enrolled. 19 CMV seropostive (R⫹) patients received 4-weeks of intravenous ganciclovir, while 3 R⫹ pediatric, and 9 D⫹/R- patients additionally received CMV hyperimmune serum (CMVIG) for 3 months and valganciclovir for up to day 80 after HT. CMV was monitored by PCR for viral DNA on peripheral blood neutrophils sampled at scheduled intervals. Major outcome measures were change in lumen, intimal and total coronary volumes from baseline to follow-up study. Although CMV DNA was detected in 30 (96%) of the 31 patients enrolled, none of them had signs of CMV disease. Despite the baseline higher risk of CMV infection, the 12 patients who received the