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)