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Temporal Changes in Left Ventricular Systolic Function and Use of Echocardiography in Adult Heart Donors

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Abstract

Background

One reason for refusal of donor hearts is the development of left ventricular systolic dysfunction, a condition reported to occur in up to 42 % of adults with brain death. Prior studies have suggested that appropriate donor management and evaluation of cardiac dysfunction with serial echocardiography (TTE) can improve organ procurement. The aims of our study are to examine the prevalence and describe longitudinal changes in cardiac dysfunction after brain death.

Methods

A cross-sectional study was performed using the Life Center Northwest organ database to identify potential adult heart donors diagnosed with brain death between January 2011 and November 2013. 246 potential donors with at least one TTE following brain death were identified. 58 donors received serial TTEs. Echocardiograms were reviewed for cardiac dysfunction, defined as left ventricular ejection fraction (EF) <50 % and/or presence of regional wall motion abnormalities.

Results

Cardiac dysfunction was present in 74 (30 %) patients. Age, body mass index, EF, and proportion of harvested organs differed significantly between the groups with and without cardiac dysfunction. Among patients receiving serial TTEs, 29 patients had cardiac dysfunction on initial TTE, with 15 (52 %) of these patients demonstrating resolved cardiac dysfunction over time leading to organ harvest.

Conclusions

To our knowledge, the present study is the largest study describing the use of serial TTE and its utilization in adult donors. The prevalence of cardiac dysfunction after adult brain death is high, but given enough time and support, many of these donors have improvement in cardiac function, ultimately leading to transplantation.

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Acknowledgement

The authors wish to thank the management and staff of Life Center Northwest for their help and support in gathering clinical records, databases, and materials for our analysis. This study was supported, in part, by an NRSA T32 (T32 GM086270) training grant.

Conflict of interest

Xenia Borbely, Vijay Krishnamoorthy, Shan Modi, Ali Rowhani-Rahbar, Edward Gibbons, and Monica Vavilala declare that they have no conflict of interest. Michael Souter is receiving 10 % institutional salary support through Life Center Northwest.

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Authors and Affiliations

  1. Department of Anesthesiology and Pain Medicine, Harborview Medical Center, University of Washington, 325 Ninth Avenue, Box 359724, Seattle, WA, 98104, USA

    Xenia I. Borbely, Vijay Krishnamoorthy, Shan Modi, Michael J. Souter & Monica S. Vavilala

  2. Department of Epidemiology, University of Washington, Seattle, WA, USA

    Ali Rowhani-Rahbar

  3. Harborview Injury Prevention and Research Center, Seattle, WA, USA

    Xenia I. Borbely, Vijay Krishnamoorthy, Shan Modi, Ali Rowhani-Rahbar, Michael J. Souter & Monica S. Vavilala

  4. Division of Cardiology, University of Washington, Seattle, WA, USA

    Edward Gibbons

Authors
  1. Xenia I. Borbely
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  2. Vijay Krishnamoorthy
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  3. Shan Modi
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  4. Ali Rowhani-Rahbar
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  5. Edward Gibbons
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  6. Michael J. Souter
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  7. Monica S. Vavilala
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Correspondence to Xenia I. Borbely.

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Borbely, X.I., Krishnamoorthy, V., Modi, S. et al. Temporal Changes in Left Ventricular Systolic Function and Use of Echocardiography in Adult Heart Donors. Neurocrit Care 23, 66–71 (2015). https://doi.org/10.1007/s12028-014-0101-x

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