High-risk heart grafts: effective preservation with Celsior solution
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Celsior solution has already proved effective in heart graft preservation because it reduces myocardial edema, prevents free radical damage, and limits calcium overload. The aim of this study was to evaluate the effectiveness of Celsior solution as myocardial protection in high-risk transplantation. Hospital charts and follow-up data of 200 consecutive heart recipients (162 males, 38 females, mean age 47.4 ± 12.6 years) were reviewed. Patients were divided into two groups: group A (73 patients) included recipients of high-risk grafts (at least two of the following: age >45; female sex; high preretrieval inotropic support, viz. dobutamine or dopamine >10 µg/kg per minute and/or infusion of norepinephrine regardless of its dosage; size mismatch >20%; ischemia time >180 min) and group B (127 patients) included recipients of standard grafts. Quality of preservation was assessed through enzyme release, echocardiographic evaluation, the need for inotropic support or pacemaker, and histology of biopsy samples. Hospital and 1-year mortality were also evaluated. Comparisons between the two groups were made through univariate analysis. Study groups proved homogeneous as to recipient age, pretransplant cardiomyopathy, status at transplantation, mean panel reactive antibodies, and redo cardiac surgery. Hospital mortality was 8% (11% vs 6.3%, P = 0.18) while 1-year mortality reached 12% (15.1% vs 10.2%, P = 0.6) without significant difference between groups. Graft performance as described by the need for inotropic support and/or pacemaker as well as echocardiography (left and right ventricular ejection fraction) proved comparable. There were no significant differences as to histology findings and patterns of enzyme release. Celsior provides optimal myocardial preservation in both standard and high-risk procedures. Such advances help to enhance donor pool expansion.
Key wordsHeart transplantation Organ preservation Cardioplegic solution Postoperative outcome
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- 1.Southard, JH 1999Organ preservationKlintmalm, GBLevy, MF eds. Organ procurement and preservationLandes BioscienceAustin6379Google Scholar
- 2.Singh, A, Lee, KJ, Lee, CY, Golfarb, RD, Tsan, MF 1989Relation between myocardial glutathione content and extent of ischemia reperfusion injuryCirculation8017901804Google Scholar
- 9.Menasche, P, Termignon, JL, Pradier, F, Grousset, C, Mouas, C, Alberici, G, Weiss, M, Piwnica, A, Bloch, G 1994Experimental evaluation of Celsior, a new heart preservation solutionEur J Thorac Cardiovasc Surg8207213Google Scholar
- 10.Ackermann, J, Gross, W, Mory, M, Schaefer, M, Gebhard, MM 2002Celsior versus Custodiol: early postischemic recovery after cardioplegia and ischemia at 5°CAnn Thorac Surg74522529Google Scholar
- 11.Vega, JD, Ochsner, JL, Jeevanandam, V, McGiffin, DC, McCurry, KR, Mentzer, RM,Jr, Stringham, JC, Pierson, RN,3rd, Frazier, OH, Menkis, AH, Staples, ED, Modry, DL, Emery, RW, Piccione, W,Jr, Carrier, M, Hendry, PJ, Aziz, S, Furukawa, S, Pham, SM 2001A multicenter, randomized, controlled trial of Celsior for flush and hypothermic storage of cardiac allograftAnn Thorac Surg7114421447CrossRefPubMedGoogle Scholar
- 12.Remadi, JP, Baron, O, Roussel, JC, Al Habash, O, Treilhaud, M, Despins, P, Duveau, D, Michaud, J 2002Myocardial preservation using Celsior solution in cardiac transplantation: early results and 5-year follow-up of a multicenter prospective study of 70 cardiac transplantationsAnn Thorac Surg7314951499CrossRefPubMedGoogle Scholar
- 13.Bennett LE, Keck BM, Hertz MI, Trulock EP, Taylor DO (2001) Worldwide thoracic organ transplantation: a report from the UNOS/ISHLT international registry for thoracic organ transplantation. Clin Transpl 25–40Google Scholar
- 16.Livi, U, Milano, A, Bortolotti, U, Casula, R, Zenati, M, Casarotto, D 1994Results of heart transplantation by extending recipient selection criteriaJ Cardiovasc Surg35377382Google Scholar
- 21.Anyawu, AC, Rogers, CA, Murday, AJ 1999Should recipient risk be a factor in choosing recipients for suboptimal donor hearts: a multi-institutional studyTransplant Proc3113991400Google Scholar
- 22.Wildhirt, SM, Weis, M, Schulze, C, Conrad, N, Rieder, G, Enders, G, Ihnken, K, von Scheidt, W, Reichart, B 2000Effects of Celsior and University of Wisconsin preservation solutions on hemodynamics and endothelial function after cardiac transplantation in humans: a single-center, prospective, randomised trialTransplant Int13203211Google Scholar
- 23.Wieselthaler, GM, Chevtchik, O, Konetschny, R, Moidl, R, Mallinger, R, Mares, P, Griessmacher, A, Grimm, M, Wolner, E, Laufer, G 1999Improved graft function using a new myocardial preservation solution: Celsior. Preliminary data from a prospective studyTransplant Proc3120672068CrossRefPubMedGoogle Scholar