- Email: [email protected]
Orthotopic heart transplantation with prolonged donor ischemic time: report of 3 cases and literature review
Journal of Medical Colleges of PLA 24 (2009) 235–238
आऋऑऎऊࣽईࣜऋंࣜ उँऀअࣿࣽईࣜ ࣿऋईईँःँएࣜऋंࣜऌईࣽ www.elsevier.com/locate/jmcpla
Orthotopic heart transplantation with prolonged donor ischemic time: report of 3 cases and literature review Zhang Zaigao*, Xie Shuiben, Xue Zhiqiang, Bei Yajun, Zhao Zhe Department of Cardiovascular Surgery, Navy General Hospital, Beijing 100037, China Received 10 December 2008; accepted 05 March 2009
Abstract Objective: Heart transplantation has become an effective therapy for patients with end stage heart failure. The preservation of the donor heart is an important factor that affects the results of the operation. We performed 3 cases of orthotopic heart transplantation and obtained some experience in the preservation of the donor heart. Methods: Three male patients with end stage heart failure received the operation in our department successfully. Doppler echocardiography showed left ventricular end diameter (LVED) of the patients were 91, 87, and 83 mm, and ejection fraction (EF) were 24%, 20%, 12.9%, respectively. Once the declaration of brain death had been made, the median sternotomy was performed with a sternal saw. Haparin at a dose of 300 U/kg of body weight was administered. After at least 2-min heparin circulation, the procurement proceeded. The superior vena cava and the inferior vena cava were nearly completely divided. When the heart was empty, the ascending aorta was cross-clamped and the St. Thomas solution was infused by gravity. The heart was excised by transection of the inferior vena cava, the superior vena cava and all pulmonary veins. After donor heart was removed, it was infused with University of Wisconsin (UW) solution by gravity at a temperature of 4–6 ć, then placed in UW solution for storage during transportation. The temperature of solution was maintained at about 4–6 ć. The ischemic times of donor heart were 9, 8 and 6 h, respectively. The bicaval anastomotic heart transplantation was adopted. The left atrial anastomoses were constructed using 3.0 polypropylene. The inferior vene cava anastomosis was constructed, the donor and native aorta were cut to an appropriate length. Then the aorta and main pulmonary artery anastomosis were performed respectively. The superior vene cava anastomosis was usually constructed during the rewarming phase. The intraoperative course with a cardiopulmonary bypass of the 3 patients was 96, 44 and 49 min, respectively. Standard triple immunosuppression therapy was commenced in the immediate post-operative period. Results: The operation procedure was smooth and no perioperative death occurred. The follow-up was carried out carefully. The patient’s condition was fine in 25, 30 and 32 months after operation. The blood pressure was 130/90, 140/95 and 120/80 mmHg, respectively, and LVED was 51, 49 and 53 mm; EF was 50%, 54% and 60%, respectively. Cardiothoracic ratio was 0.63, 0.55, and 0.64, respectively. Conclusion: Preservation time of donor heart with St. Thomas solution infusion and UW solution storage at 0–4 ć may exceed 6 h, and receive comparable middle-term outcomes. Keywords: Heart transplantation; Dilated cardiomyopathy; Myocardial protection; Donor heart preservation *
Corresponding author. E-mail address: [email protected] (Zhang Z.)
236
Zhang Zaigao et al. / Journal of Medical Colleges of PLA 24 (2009) 235–238
1. Introduction
showed LVED 91 mm and EF 24%. Chest X-ray showed the cardiothoracic ratio of dilated heart was
In recent years, heart transplantation has become an effective therapy for patients with end stage heart
0.79. The heart function was Č according NYHA at admission.
failure. Currently, heart preservation is limited to 3 to 5
Case 3. The patient, a 24-year-old man of blood
h of cold ischemic storage. Three patients underwent
type O, was admitted to our department in June 2005
orthotopic heart transplantation with donor ischemic
because of refractory heart failure with progressive
time over 6 h at Navy General Hospital from March 1,
dyspnea for 2 years. He had undergone cardiac surgery
2005 to August 31, 2005, and the middle-term
of mitral valve replacement 4 years ago at other hospital.
outcomes were satisfactory.
His condition deteriorated 2 years late after operation. Since medical treatment with diuretics, digitalis,
2. Materials and methods
dopamine,
milrinone,
and
angiotensin-converting
enzyme inhibitor was ineffective to improve the
2.1. Pre-transplantation data
hemodynamic and clinical status, he was putted on the waiting list for heart transplantation. Heart rate was
Case 1. The patient, a 36-year-old man of blood
95/min and blood pressure 100/60 mmHg. Heart
type O, was admitted for end dilated cardiomyopathy
enlarged and grade Ċ/Ď harsh blowing systolic murmur
with complaints such as paroxysmal nocturnal dyspnea,
heard at the apical area. Doppler echocardiography
orthopnea, frequent ventricular tachycardia, lower
showed LVED 87 mm and EF 12.9%. Chest X-ray
extremity edema for 2 years. Heart rate was 90/min and
showed the cardiothoracic ratio of dilated heart was 0.72.
blood pressure 110/75 mmHg. Heart enlarged and grade
The heart function was Č according NYHA at
ċ/Ď harsh blowing systolic murmur heard at the
admission.
apical area with no thrill or diastolic murmur heard. Doppler echocardiography showed that the left
2.2. Operation procedure
ventricular end diameter (LVED) was 73 mm and the ejection fraction (EF) was 24%. Chest radiography
The donors were male, and 20, 23, 28 years old,
showed the cardiothoracic ratio of dilated heart was
respectively. The blood type of the donors were O, A
0.71. The heart function was Č according NYHA at
and O. Once the declaration of brain death had been
admission.
made, the median sternotomy was performed with a
Case 2. The patient, a 32-year-old man of blood
sternal saw. Haparin at a dose of 300 U/kg of body
type AB, was admitted for end dilated cardiomyopathy
weight was administered. After at least 2-min heparin
with complaints of dyspnea on physical exertion,
circulation, the procurement could proceed. The
decreased exercise tolerance, and lower extremity
superior vena cava was cross-clamped and the inferior
edema for 3 years and worsening in the last 2 months.
vena cava was nearly completely divided, and the heart
Heart rate was 90/min and blood pressure 115/70
should be allowed to continue beating to exsanguinate
mmHg. Heart enlarged and grade Ċ/Ď harsh blowing
the blood through this inferior vena caval incision.
systolic murmur heard at the apical area with no thrill
When the heart was empty the ascending aorta was
or diastolic murmur heard. Doppler echocardiography
cross-clamped and the St. Thomas solution was
237
Zhang Zaigao et al. / Journal of Medical Colleges of PLA 24 (2009) 235–238
commenced by gravity infusion. To prevent left
The anastomosis was constructed with continuous
ventricular distention, the right pulmonary veins were
5-0 polypropylene. The remainder of the operation
divided. When the preservation solution infusion was
was conducted as usual during rewarming, and
complete, the heart was excised by completing the
cardiopulmonary
transection of the inferior vena cava transecting the
discontinuted.
superior vena cava as cephalad as possible and all
discontinuation of CPB, the function of each ventricle
pulmonary veins. After removal of the heart, it was
was assessed with TEE and appropriate interventions
infused with UW solution by gravity at a temperature of
were made, if necessary, to improve function. The
4–6 ć, then placed in UW solution for storage during
intraoperative course with a cardiopulmonary bypass
transport. The solution was maintained at about 4–6 ć
were 96, 44, 49 min, respectively.
bypass
(CPB)
Immediately
was
before
gradually and
after
by packing the plastic bag in ice, which did not come in direct contact with the heart. The ischemic times of
3. Results
donor heart were 8, 9 and 6 h, respectively. In addition to the usual preparation for cardiac
Standard triple immunosuppression therapy was
operations, a Swan-Ganz floating catheter was placed
commenced in the immediate post-operative period
through the left internal jugular vein after induction of
with cyclosporin (3–5 mg/kg), azathioprime(2 mg/kg),
general anesthesia, and the pulmonary artery pressure
prednisolone (0.75–0.125 mg/kg for daily dose). The
and right ventricular pressure were monitored. The
postoperative course was also uneventful. The 25-, 30-,
heart was exposed through a median sternotomy. When
32-month follow-up revealed very good results. In
the donor heart was imminent, cardiopulmonary bypass
detail, the blood pressure were 130/90, 140/90, 120/80
was established with separate caval cannulation.
mmHg. Echo revealed LVED were 51, 49 and 53 mm,
Additional time was allotted if extensive dissection was
EF
necessary. The aorta was cross-clamped and a standard
Cardiothoracic ratio was 0.63, 0.56, and 0.64,
cardiectomy was performed, leaving a cuff of left
respectively.
were
50%,
54%
and
60%,
respectively.
atrium and dividing the great vessels proximally. The bicaval anastomotic heart transplatation was operated.
4. Discussion
The great vessels were accurately dissected free one from the other to facilitate the great vessel anastomosis.
While transplantation is a proven modality for the
The left atrial anastomosis is constructed using
treatment of end stage organ disease, an important
continuous 3.0 polypropylene. The inferior vena cava
determinant of outcome is the adequacy of organ
(IVC) anastomosis was constructed. The aortic
preservation. The success of organ transplantation is
anastomosis is constructed with continuous 4.0
critically dependent on the quality of the donor organ
polypropylene after the donor and native aorta were cut
[1–3]. The quality donor organ determined by a variety
to an appropriate length. Then the main pulmonary
of factors, such as the donor age and preexisting disease,
artery anastomosis was performed. The superior vena
the mechanism of brain death, the duration of
cava (SVC) anastomosis was usually constructed
hypothermic storage. Currently, heart preservation is
during the rewarming phase (prior to the pulmonary
limited to 4 to 5 h of cold ischemic storage. Some
artery anastomosis) with a beating, re-perfused heart.
studies indicate that the risk of primary graft failure and
238
Zhang Zaigao et al. / Journal of Medical Colleges of PLA 24 (2009) 235–238
death rises dramatically as ischemic time increases [4].
donor age, with greater tolerance for prolonged
Three
heart
ischemic times among grafts from younger donors.
transplantation with donor ischemic time over 6 h at our
Both donor age and anticipated ischemic time must be
department for donor hearts were being harvested from
considered when assessing a potential donor.
patients
underwent
orthotopic
remote locations, and the middle-term results were satisfactory. We attempt to explore the experiences of
References
the 3 heart transplantation it may help us expand the potential donor pool by using cardiac allografts with
1.
prolonged ischemic time.
Katare RG, Zhitian Z, Sodeoka M, et al. A novel bisindolylmaleimide
Traditionally, hypothermic storage of the donor
enhances
functional
recovery of heart after long term hypothermic heart
organ has been used to protect it from ischemic injury. We used St. Thomas solution to infuse the donor heart
derivative
preservation. Transplantation 2007; 83 (12): 1588–1594. 2.
Sievers HH, Legh R, Jahnke A, et al. Bicaval versus
to remove the blood of coronary vessel, and induce the
atrial anastomoses in cardiac transplantation. J Thorac
heart hypothermia and arrest immediately. It is very
Cardiovasc Surg 1994; 108 (4): 780–784.
important to decrease the warm ischemic time. UW
3.
Aziz T, Burgess M, Khafagy R, et al. Bicaval and
solution has already been proved effective in heart graft
standard techniques in orthotopic heart transplantation:
preservation because it reduces myocardial edema,
Medium term experience in cardiac performance and
prevents free radical damage, and limits calcium
survival. J Thorac Cardiovasc Surg 1999; 118 (1):
overload [1, 5]. Temperature of the solution is also
115–122.
important, in that endothelial dysfunction after standard
4.
Russo MJ, Chen JM, Sorabella RA, et al. The effect of
UW solution is minimized with temperatures of 4 ć to
ischemic time on survival after heart transplantation
10 ć. Our data also proved UW solution storage was a
varies by donor age: An analysis of the United Network
good method to preserve donor heart, and may break
for Organ Sharing database. J Thorac Cardiovasc Surg
the usual time limitation. Our experiences demonstrates
2007; 133 (2): 554–559.
that the effect of ischemic time on survival after heart
5.
Wang CS, Chen H, Hong T, et al. Orthotopic heart
transplantation is dependent on donor age, with greater
transplantation:clinical experience on 56 patients. Zhonghua
tolerance for prolonged ischemic times among grafts
Yi Xue Za Zhi 2004; 84 (19): 1589–1591. (In Chinese)
from younger donors [4]. Preservation time of donor
6.
Morgan JA, John R, Weinberg AD, et al. Prolonged donor
heart with St. Thomas solution perfusion and UW
ischemic time does not adversely affect long-term survival
solution storage at 0–4 ć may exceed 6 h and receive
in adult patients undergoing cardiac transplantation. J
comparable
Thorac Cardiovasc Surg 2003; 126 (5): 1624–1633.
clinical
outcomes.
Prolonged
donor
ischemic time is not a risk factor for decreased middle-term survival [5, 6]. The effect of ischemic time on survival after heart transplantation is dependent on
(Editor Guo Jianxiu)
आऋऑऎऊࣽईࣜऋंࣜ उँऀअࣿࣽईࣜ ࣿऋईईँःँएࣜऋंࣜऌईࣽ www.elsevier.com/locate/jmcpla
Orthotopic heart transplantation with prolonged donor ischemic time: report of 3 cases and literature review Zhang Zaigao*, Xie Shuiben, Xue Zhiqiang, Bei Yajun, Zhao Zhe Department of Cardiovascular Surgery, Navy General Hospital, Beijing 100037, China Received 10 December 2008; accepted 05 March 2009
Abstract Objective: Heart transplantation has become an effective therapy for patients with end stage heart failure. The preservation of the donor heart is an important factor that affects the results of the operation. We performed 3 cases of orthotopic heart transplantation and obtained some experience in the preservation of the donor heart. Methods: Three male patients with end stage heart failure received the operation in our department successfully. Doppler echocardiography showed left ventricular end diameter (LVED) of the patients were 91, 87, and 83 mm, and ejection fraction (EF) were 24%, 20%, 12.9%, respectively. Once the declaration of brain death had been made, the median sternotomy was performed with a sternal saw. Haparin at a dose of 300 U/kg of body weight was administered. After at least 2-min heparin circulation, the procurement proceeded. The superior vena cava and the inferior vena cava were nearly completely divided. When the heart was empty, the ascending aorta was cross-clamped and the St. Thomas solution was infused by gravity. The heart was excised by transection of the inferior vena cava, the superior vena cava and all pulmonary veins. After donor heart was removed, it was infused with University of Wisconsin (UW) solution by gravity at a temperature of 4–6 ć, then placed in UW solution for storage during transportation. The temperature of solution was maintained at about 4–6 ć. The ischemic times of donor heart were 9, 8 and 6 h, respectively. The bicaval anastomotic heart transplantation was adopted. The left atrial anastomoses were constructed using 3.0 polypropylene. The inferior vene cava anastomosis was constructed, the donor and native aorta were cut to an appropriate length. Then the aorta and main pulmonary artery anastomosis were performed respectively. The superior vene cava anastomosis was usually constructed during the rewarming phase. The intraoperative course with a cardiopulmonary bypass of the 3 patients was 96, 44 and 49 min, respectively. Standard triple immunosuppression therapy was commenced in the immediate post-operative period. Results: The operation procedure was smooth and no perioperative death occurred. The follow-up was carried out carefully. The patient’s condition was fine in 25, 30 and 32 months after operation. The blood pressure was 130/90, 140/95 and 120/80 mmHg, respectively, and LVED was 51, 49 and 53 mm; EF was 50%, 54% and 60%, respectively. Cardiothoracic ratio was 0.63, 0.55, and 0.64, respectively. Conclusion: Preservation time of donor heart with St. Thomas solution infusion and UW solution storage at 0–4 ć may exceed 6 h, and receive comparable middle-term outcomes. Keywords: Heart transplantation; Dilated cardiomyopathy; Myocardial protection; Donor heart preservation *
Corresponding author. E-mail address: [email protected] (Zhang Z.)
236
Zhang Zaigao et al. / Journal of Medical Colleges of PLA 24 (2009) 235–238
1. Introduction
showed LVED 91 mm and EF 24%. Chest X-ray showed the cardiothoracic ratio of dilated heart was
In recent years, heart transplantation has become an effective therapy for patients with end stage heart
0.79. The heart function was Č according NYHA at admission.
failure. Currently, heart preservation is limited to 3 to 5
Case 3. The patient, a 24-year-old man of blood
h of cold ischemic storage. Three patients underwent
type O, was admitted to our department in June 2005
orthotopic heart transplantation with donor ischemic
because of refractory heart failure with progressive
time over 6 h at Navy General Hospital from March 1,
dyspnea for 2 years. He had undergone cardiac surgery
2005 to August 31, 2005, and the middle-term
of mitral valve replacement 4 years ago at other hospital.
outcomes were satisfactory.
His condition deteriorated 2 years late after operation. Since medical treatment with diuretics, digitalis,
2. Materials and methods
dopamine,
milrinone,
and
angiotensin-converting
enzyme inhibitor was ineffective to improve the
2.1. Pre-transplantation data
hemodynamic and clinical status, he was putted on the waiting list for heart transplantation. Heart rate was
Case 1. The patient, a 36-year-old man of blood
95/min and blood pressure 100/60 mmHg. Heart
type O, was admitted for end dilated cardiomyopathy
enlarged and grade Ċ/Ď harsh blowing systolic murmur
with complaints such as paroxysmal nocturnal dyspnea,
heard at the apical area. Doppler echocardiography
orthopnea, frequent ventricular tachycardia, lower
showed LVED 87 mm and EF 12.9%. Chest X-ray
extremity edema for 2 years. Heart rate was 90/min and
showed the cardiothoracic ratio of dilated heart was 0.72.
blood pressure 110/75 mmHg. Heart enlarged and grade
The heart function was Č according NYHA at
ċ/Ď harsh blowing systolic murmur heard at the
admission.
apical area with no thrill or diastolic murmur heard. Doppler echocardiography showed that the left
2.2. Operation procedure
ventricular end diameter (LVED) was 73 mm and the ejection fraction (EF) was 24%. Chest radiography
The donors were male, and 20, 23, 28 years old,
showed the cardiothoracic ratio of dilated heart was
respectively. The blood type of the donors were O, A
0.71. The heart function was Č according NYHA at
and O. Once the declaration of brain death had been
admission.
made, the median sternotomy was performed with a
Case 2. The patient, a 32-year-old man of blood
sternal saw. Haparin at a dose of 300 U/kg of body
type AB, was admitted for end dilated cardiomyopathy
weight was administered. After at least 2-min heparin
with complaints of dyspnea on physical exertion,
circulation, the procurement could proceed. The
decreased exercise tolerance, and lower extremity
superior vena cava was cross-clamped and the inferior
edema for 3 years and worsening in the last 2 months.
vena cava was nearly completely divided, and the heart
Heart rate was 90/min and blood pressure 115/70
should be allowed to continue beating to exsanguinate
mmHg. Heart enlarged and grade Ċ/Ď harsh blowing
the blood through this inferior vena caval incision.
systolic murmur heard at the apical area with no thrill
When the heart was empty the ascending aorta was
or diastolic murmur heard. Doppler echocardiography
cross-clamped and the St. Thomas solution was
237
Zhang Zaigao et al. / Journal of Medical Colleges of PLA 24 (2009) 235–238
commenced by gravity infusion. To prevent left
The anastomosis was constructed with continuous
ventricular distention, the right pulmonary veins were
5-0 polypropylene. The remainder of the operation
divided. When the preservation solution infusion was
was conducted as usual during rewarming, and
complete, the heart was excised by completing the
cardiopulmonary
transection of the inferior vena cava transecting the
discontinuted.
superior vena cava as cephalad as possible and all
discontinuation of CPB, the function of each ventricle
pulmonary veins. After removal of the heart, it was
was assessed with TEE and appropriate interventions
infused with UW solution by gravity at a temperature of
were made, if necessary, to improve function. The
4–6 ć, then placed in UW solution for storage during
intraoperative course with a cardiopulmonary bypass
transport. The solution was maintained at about 4–6 ć
were 96, 44, 49 min, respectively.
bypass
(CPB)
Immediately
was
before
gradually and
after
by packing the plastic bag in ice, which did not come in direct contact with the heart. The ischemic times of
3. Results
donor heart were 8, 9 and 6 h, respectively. In addition to the usual preparation for cardiac
Standard triple immunosuppression therapy was
operations, a Swan-Ganz floating catheter was placed
commenced in the immediate post-operative period
through the left internal jugular vein after induction of
with cyclosporin (3–5 mg/kg), azathioprime(2 mg/kg),
general anesthesia, and the pulmonary artery pressure
prednisolone (0.75–0.125 mg/kg for daily dose). The
and right ventricular pressure were monitored. The
postoperative course was also uneventful. The 25-, 30-,
heart was exposed through a median sternotomy. When
32-month follow-up revealed very good results. In
the donor heart was imminent, cardiopulmonary bypass
detail, the blood pressure were 130/90, 140/90, 120/80
was established with separate caval cannulation.
mmHg. Echo revealed LVED were 51, 49 and 53 mm,
Additional time was allotted if extensive dissection was
EF
necessary. The aorta was cross-clamped and a standard
Cardiothoracic ratio was 0.63, 0.56, and 0.64,
cardiectomy was performed, leaving a cuff of left
respectively.
were
50%,
54%
and
60%,
respectively.
atrium and dividing the great vessels proximally. The bicaval anastomotic heart transplatation was operated.
4. Discussion
The great vessels were accurately dissected free one from the other to facilitate the great vessel anastomosis.
While transplantation is a proven modality for the
The left atrial anastomosis is constructed using
treatment of end stage organ disease, an important
continuous 3.0 polypropylene. The inferior vena cava
determinant of outcome is the adequacy of organ
(IVC) anastomosis was constructed. The aortic
preservation. The success of organ transplantation is
anastomosis is constructed with continuous 4.0
critically dependent on the quality of the donor organ
polypropylene after the donor and native aorta were cut
[1–3]. The quality donor organ determined by a variety
to an appropriate length. Then the main pulmonary
of factors, such as the donor age and preexisting disease,
artery anastomosis was performed. The superior vena
the mechanism of brain death, the duration of
cava (SVC) anastomosis was usually constructed
hypothermic storage. Currently, heart preservation is
during the rewarming phase (prior to the pulmonary
limited to 4 to 5 h of cold ischemic storage. Some
artery anastomosis) with a beating, re-perfused heart.
studies indicate that the risk of primary graft failure and
238
Zhang Zaigao et al. / Journal of Medical Colleges of PLA 24 (2009) 235–238
death rises dramatically as ischemic time increases [4].
donor age, with greater tolerance for prolonged
Three
heart
ischemic times among grafts from younger donors.
transplantation with donor ischemic time over 6 h at our
Both donor age and anticipated ischemic time must be
department for donor hearts were being harvested from
considered when assessing a potential donor.
patients
underwent
orthotopic
remote locations, and the middle-term results were satisfactory. We attempt to explore the experiences of
References
the 3 heart transplantation it may help us expand the potential donor pool by using cardiac allografts with
1.
prolonged ischemic time.
Katare RG, Zhitian Z, Sodeoka M, et al. A novel bisindolylmaleimide
Traditionally, hypothermic storage of the donor
enhances
functional
recovery of heart after long term hypothermic heart
organ has been used to protect it from ischemic injury. We used St. Thomas solution to infuse the donor heart
derivative
preservation. Transplantation 2007; 83 (12): 1588–1594. 2.
Sievers HH, Legh R, Jahnke A, et al. Bicaval versus
to remove the blood of coronary vessel, and induce the
atrial anastomoses in cardiac transplantation. J Thorac
heart hypothermia and arrest immediately. It is very
Cardiovasc Surg 1994; 108 (4): 780–784.
important to decrease the warm ischemic time. UW
3.
Aziz T, Burgess M, Khafagy R, et al. Bicaval and
solution has already been proved effective in heart graft
standard techniques in orthotopic heart transplantation:
preservation because it reduces myocardial edema,
Medium term experience in cardiac performance and
prevents free radical damage, and limits calcium
survival. J Thorac Cardiovasc Surg 1999; 118 (1):
overload [1, 5]. Temperature of the solution is also
115–122.
important, in that endothelial dysfunction after standard
4.
Russo MJ, Chen JM, Sorabella RA, et al. The effect of
UW solution is minimized with temperatures of 4 ć to
ischemic time on survival after heart transplantation
10 ć. Our data also proved UW solution storage was a
varies by donor age: An analysis of the United Network
good method to preserve donor heart, and may break
for Organ Sharing database. J Thorac Cardiovasc Surg
the usual time limitation. Our experiences demonstrates
2007; 133 (2): 554–559.
that the effect of ischemic time on survival after heart
5.
Wang CS, Chen H, Hong T, et al. Orthotopic heart
transplantation is dependent on donor age, with greater
transplantation:clinical experience on 56 patients. Zhonghua
tolerance for prolonged ischemic times among grafts
Yi Xue Za Zhi 2004; 84 (19): 1589–1591. (In Chinese)
from younger donors [4]. Preservation time of donor
6.
Morgan JA, John R, Weinberg AD, et al. Prolonged donor
heart with St. Thomas solution perfusion and UW
ischemic time does not adversely affect long-term survival
solution storage at 0–4 ć may exceed 6 h and receive
in adult patients undergoing cardiac transplantation. J
comparable
Thorac Cardiovasc Surg 2003; 126 (5): 1624–1633.
clinical
outcomes.
Prolonged
donor
ischemic time is not a risk factor for decreased middle-term survival [5, 6]. The effect of ischemic time on survival after heart transplantation is dependent on
(Editor Guo Jianxiu)