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517: Dextrane Free Preservation Improves Early Graft Function in Porcine Single Lung Transplantation after 24 Hours of Cold Ischemia
Abstracts 517 Dextrane Free Preservation Improves Early Graft Function in Porcine Single Lung Transplantation after 24 Hours of Cold Ischemia B. Gohrbandt,1 M. Avsar,1 G. Warnecke,1 S.P. Sommer,2 A. Haverich,1 M. Strueber.1 1Hannover Medical School, Hannover, Germany; 2 University Hospital of Wuerzburg, Wuerzburg, Germany. Purpose: Dextrane containing extracellular-type preservation solution (low potassium dextrane, LPD) is widely accepted as gold standard for pulmonary preservation. We compared the effects of dextrane-free and dextrane-containing compositions in a porcine lung transplantation model. Methods and Materials: 18 porcine single left lung transplants were performed in 3 groups. LPD, Celsior and dextrane-enriched Celsior (Celdex) were employed. All lungs were flush preserved by 1l solution at 4°C. Lungs were stored semi-inflated and immersed in preservation solution for 24 hours at 4°C. After transplantation, the right recipient bronchus and pulmonary artery were clamped and the animals remained fully dependent on the grafted lung. Results: 4 animals each in the LPD and Celsior groups and 3 Celdex animals survived 7 hours of reperfusion. The remaining 2 LPD, 2 Celsior and 3 Celdex animals died from right heart failure due to severe lung ischemia-reperfusion injury. Mean oxygenation indices were reduced in the dextrane-containing groups (LPD 341⫾225, Celdex 233⫾84) as compared to the Celsior group (387⫾146; P⬍0.0001, repeated-measures ANOVA). Pulmonary vascular resistance (Celsior 584⫾194, LPD 1310⫾620, Celdex 910⫾179 dyn*s⫺1*cm⫺5 at 7h; P⬍0.0001, repeated-measures ANOVA) remained significantly lower in the dextrane free Celsior group. Wet-to-dry lung weight ratios did not differ significantly among groups (LPD 8.1⫾0.8, Celsior 8.4⫾0.8, Celdex 10.3⫾1.1; P⬎0.05) after termination of the experiment. Conclusions: Functional lung graft parameters deteriorated after dextrane enriched preservation. Based on these results and additional results from earlier studies we changed our clinical lung preservation strategy to employing dextrane-free solution.
518 Respiratory Morbidity Associated with the Berlin Heart in Children A. Hosenie, A. Hasan, C. O’Brien, M. Griselli, R. Kirk, J.H. Smith, S.R. Haynes, J.V. Cassidy. Freeman Hospital, Newcastle upon Tyne, United Kingdom. Purpose: Berlin Heart (BH) use in children with end stage heart failure as bridge to transplant (BTT) or recovery enables significantly longer cardiac mechanical support times than previously possible.We review coexisting respiratory morbidity in this group. Methods and Materials: Retrospective review of 26 children on BH support in our institution since November 2005. Results: 26 children received BH support over 1379 days. Median age was 2 years (range 10 weeks-15 years). Median support time was 39 days (range 7-150). Intention at implantation was BTT but 6 children showed sufficient improvement in their cardiac function for explantation. 7 children were on ECMO support pre BH. Survival to transplant or BH explant was 77% and survival to discharge 68%.1 child remains on support. Median time ventilated post BH insertion was 14 days (range 2-150). 7 (27%) children required ⬎4 weeks ventilation. 9 (35%) required ventilation throughout their BH course. 5 children required tracheostomy for ongoing respiratory support. 3 had significant tracheobronchomalacia (TBM) on bronchoscopy. 3 had a phrenic nerve palsy requiring diaphragm plication. Tracheostomy need was unrelated to age but all children requiring either diaphragm plication or prolonged ventilation for TBM were ⬍3 years. Length of ventilation on BH did not relate to age at implantation.[table1]It did relate to use of biventricular support rather than left ventricular support alone.[table2]2 children were discharged post cardiac transplant on non invasive ventilation. Both are now well and no longer on support.
S169 Outcome by age
Age
No
total days BH use
0-12 mths 1-5 yrs 5-10 yrs ⬎10 yrs
7 12 4 3
361 654 216 148
total days ventilation
Ventilation throughout BH use
tracheostomy
228 277 73 51
2 3 3 1
1 2 2 1
Support mode vs respiratory complications (TBM, phrenic palsy, tracheostomy) Support
No
Days ventilated
Complications
ECMO-BIVAD LVAD BIVAD
7 8 11
276 116 237
4 0 5
Conclusions: BH respiratory morbidity is significant, commoner in patients on biventricular support and may be ongoing post discharge. However long term outcome is good. 519 Predictors of Complications after Heart Transplantation in Pediatric Patients with Restrictive Cardiomyopathy T. Shindo, J.C. Alejos, N. Halnon. David Geffen School of Medicine and Mattel Children’s Hospital, UCLA, Los Angeles, CA. Purpose: A pre-transplant diagnosis of restrictive cardiomyopathy (RCM) has been associated with early graft failure and short and long-term complications after heart transplantation (OHT) related to pulmonary hypertension (pHTN). We sought to determine risk factors for prolonged pHTN, and early right heart failure (HF), need for vasodilator therapy, or death among patients with a pre-transplant diagnosis of RCM. Methods and Materials: We performed a retrospective study of pediatric patients with RCM who underwent OHT between 1992 and 2008 at a single institution. We reviewed medical records for pre-transplant cardiac catheterization data and examined outcomes after OHT: death or graft loss, need for nitric oxide and vasodilator therapy, and time to resolve pHTN. Results: We identified 19 patients with OHT for RCM. There were 10 males and median age at OHT was 10.6 years. There was one death on POD 7 and one re-transplanted on POD 28. Both patients required ECMO within hours of OHT and had evidence of HF. Receiver operator curves were generated to determine values of pulmonary vascular resistance (PVRI), transpulmonary gradient (TPG), systolic and mean pulmonary artery pressure (sPAP and mPAP), and ratio of sPAP to systolic blood pressure (ratio) prior to OHT that predicted death, RH or need for vasodilator therapy post OHT. sPAP, mPAP, and ratio all generated an area under the curve ⬎0.9. A ratio of ⬎0.56 had a likelihood ratio of ⬎12 (AOC 1.00) and was the best single predictor. In Survivors, time after OHT to normalize mPAP was best predicted by PVRI (p⫽.005). Conclusions: Data obtained prior to OHT can predict risk for complications in patients with RCM and may be used to determine optimal timing for OHT. Patients with a ratio of mPAP to systolic pressure greater than 0.56 are likely to have early post operative complications. Importantly, ratio of sPAP to systolic blood pressure can be monitored in many patients using non-invasive echocardiography making it a useful measure to follow prior to transplant. 520 Sudden Cardiac Death (SCD) in Pediatric Patients with Transplant Coronary Artery Disease (TCAD): Does Intravascular Ultrasound have a Role in Early Diagnosis of TCAD and Prevention of SCD in These Patients? D.P. Bhat,2 C. Nasman,1 S. Worley,1 G.J. Boyle.1 1Cleveland Clinic Children’s Hospital, Cleveland, OH; 2Metrohealth Medical Center, Cleveland, OH.
518 Respiratory Morbidity Associated with the Berlin Heart in Children A. Hosenie, A. Hasan, C. O’Brien, M. Griselli, R. Kirk, J.H. Smith, S.R. Haynes, J.V. Cassidy. Freeman Hospital, Newcastle upon Tyne, United Kingdom. Purpose: Berlin Heart (BH) use in children with end stage heart failure as bridge to transplant (BTT) or recovery enables significantly longer cardiac mechanical support times than previously possible.We review coexisting respiratory morbidity in this group. Methods and Materials: Retrospective review of 26 children on BH support in our institution since November 2005. Results: 26 children received BH support over 1379 days. Median age was 2 years (range 10 weeks-15 years). Median support time was 39 days (range 7-150). Intention at implantation was BTT but 6 children showed sufficient improvement in their cardiac function for explantation. 7 children were on ECMO support pre BH. Survival to transplant or BH explant was 77% and survival to discharge 68%.1 child remains on support. Median time ventilated post BH insertion was 14 days (range 2-150). 7 (27%) children required ⬎4 weeks ventilation. 9 (35%) required ventilation throughout their BH course. 5 children required tracheostomy for ongoing respiratory support. 3 had significant tracheobronchomalacia (TBM) on bronchoscopy. 3 had a phrenic nerve palsy requiring diaphragm plication. Tracheostomy need was unrelated to age but all children requiring either diaphragm plication or prolonged ventilation for TBM were ⬍3 years. Length of ventilation on BH did not relate to age at implantation.[table1]It did relate to use of biventricular support rather than left ventricular support alone.[table2]2 children were discharged post cardiac transplant on non invasive ventilation. Both are now well and no longer on support.
S169 Outcome by age
Age
No
total days BH use
0-12 mths 1-5 yrs 5-10 yrs ⬎10 yrs
7 12 4 3
361 654 216 148
total days ventilation
Ventilation throughout BH use
tracheostomy
228 277 73 51
2 3 3 1
1 2 2 1
Support mode vs respiratory complications (TBM, phrenic palsy, tracheostomy) Support
No
Days ventilated
Complications
ECMO-BIVAD LVAD BIVAD
7 8 11
276 116 237
4 0 5
Conclusions: BH respiratory morbidity is significant, commoner in patients on biventricular support and may be ongoing post discharge. However long term outcome is good. 519 Predictors of Complications after Heart Transplantation in Pediatric Patients with Restrictive Cardiomyopathy T. Shindo, J.C. Alejos, N. Halnon. David Geffen School of Medicine and Mattel Children’s Hospital, UCLA, Los Angeles, CA. Purpose: A pre-transplant diagnosis of restrictive cardiomyopathy (RCM) has been associated with early graft failure and short and long-term complications after heart transplantation (OHT) related to pulmonary hypertension (pHTN). We sought to determine risk factors for prolonged pHTN, and early right heart failure (HF), need for vasodilator therapy, or death among patients with a pre-transplant diagnosis of RCM. Methods and Materials: We performed a retrospective study of pediatric patients with RCM who underwent OHT between 1992 and 2008 at a single institution. We reviewed medical records for pre-transplant cardiac catheterization data and examined outcomes after OHT: death or graft loss, need for nitric oxide and vasodilator therapy, and time to resolve pHTN. Results: We identified 19 patients with OHT for RCM. There were 10 males and median age at OHT was 10.6 years. There was one death on POD 7 and one re-transplanted on POD 28. Both patients required ECMO within hours of OHT and had evidence of HF. Receiver operator curves were generated to determine values of pulmonary vascular resistance (PVRI), transpulmonary gradient (TPG), systolic and mean pulmonary artery pressure (sPAP and mPAP), and ratio of sPAP to systolic blood pressure (ratio) prior to OHT that predicted death, RH or need for vasodilator therapy post OHT. sPAP, mPAP, and ratio all generated an area under the curve ⬎0.9. A ratio of ⬎0.56 had a likelihood ratio of ⬎12 (AOC 1.00) and was the best single predictor. In Survivors, time after OHT to normalize mPAP was best predicted by PVRI (p⫽.005). Conclusions: Data obtained prior to OHT can predict risk for complications in patients with RCM and may be used to determine optimal timing for OHT. Patients with a ratio of mPAP to systolic pressure greater than 0.56 are likely to have early post operative complications. Importantly, ratio of sPAP to systolic blood pressure can be monitored in many patients using non-invasive echocardiography making it a useful measure to follow prior to transplant. 520 Sudden Cardiac Death (SCD) in Pediatric Patients with Transplant Coronary Artery Disease (TCAD): Does Intravascular Ultrasound have a Role in Early Diagnosis of TCAD and Prevention of SCD in These Patients? D.P. Bhat,2 C. Nasman,1 S. Worley,1 G.J. Boyle.1 1Cleveland Clinic Children’s Hospital, Cleveland, OH; 2Metrohealth Medical Center, Cleveland, OH.