Cold ischemia >4 hours increases heart transplantation mortality. An analysis of the Spanish heart transplantation registry
Valero-Masa, M.J. ; González-Vílchez, F. ; Almenar-Bonet, L. ; Crespo-Leiro, M.G. ; Manito-Lorite, N. ; Sobrino-Márquez, J.M. ; Gómez-Bueno, M. ; Delgado-Jiménez, J.F. ; Pérez-Villa, F. ; Brossa Loidi, V. ; Arizón-el Prado, J.M. ; Díaz Molina, B. ; de la Fuente-Galán, L. ; Portoles Ocampo, A. ; Garrido Bravo, I.P. ; Rábago-Juan Aracil, G. ; Martínez-Sellés, M.
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.
Idioma: Inglés
DOI: 10.1016/j.ijcard.2020.06.009
Año: 2020
Publicado en: INTERNATIONAL JOURNAL OF CARDIOLOGY 319 (2020), 14-19
ISSN: 0167-5273
Factor impacto JCR: 4.164 (2020)
Categ. JCR: CARDIAC & CARDIOVASCULAR SYSTEMS rank: 56 / 141 = 0.397 (2020) - Q2 - T2
Factor impacto SCIMAGO: 1.405 - Cardiology and Cardiovascular Medicine (Q1)
Tipo y forma: Article (PostPrint)
You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use. You may not use the material for commercial purposes. If you remix, transform, or build upon the material, you may not distribute the modified material.
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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.
Idioma: Inglés
DOI: 10.1016/j.ijcard.2020.06.009
Año: 2020
Publicado en: INTERNATIONAL JOURNAL OF CARDIOLOGY 319 (2020), 14-19
ISSN: 0167-5273
Factor impacto JCR: 4.164 (2020)
Categ. JCR: CARDIAC & CARDIOVASCULAR SYSTEMS rank: 56 / 141 = 0.397 (2020) - Q2 - T2
Factor impacto SCIMAGO: 1.405 - Cardiology and Cardiovascular Medicine (Q1)
Tipo y forma: Article (PostPrint)
You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use. You may not use the material for commercial purposes. If you remix, transform, or build upon the material, you may not distribute the modified material. Exportado de SIDERAL (2022-04-25-10:39:32)
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Record created 2021-06-28, last modified 2022-04-25