The Safety and Late Hemodynamics of Donor Cardiac Undersizing in Heart Transplantation

IF 3.9 2区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Annals of Thoracic Surgery Pub Date : 2025-04-01 Epub Date: 2024-12-25 DOI:10.1016/j.athoracsur.2024.12.010

Chetan Pasrija MD , Alexandra Debose-Scarlett MD , Daniel K. Ragheb BS , Hasan K. Siddiqi MD, MSCR , Kaushik Amancherla MD , Douglas M. Brinkley MD , JoAnn Lindenfeld MD , Jonathan Menachem MD , Henry Ooi MD , Dawn Pedrotty MD , Lynn Punnoose MD , Shelley Scholl RN , Aniket Rali MD , Suzanne Sacks MD , Mark Wigger MD , Sandip Zalawadiya MD , Ashish Shah MD , Kelly Schlendorf MD, MHS , John Trahanas MD

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Abstract

Background

Predicted heart mass (PHM) ratio has become the standard donor-recipient size matching method in heart transplantation. Although use of small PHM ratio hearts is associated with increased 1-year mortality, the underlying mechanisms and time horizon of mortality remain uncertain.

Methods

A single-institution analysis of 334 isolated heart transplant recipients (January 2019-July 2022) was performed. Patients were stratified by PHM ratio: undersized (<0.86; n = 106), matched (0.86-1.15; n = 175), and oversized (>1.15; n = 53). Survival within PHM ratio groups was further stratified by complex transplant group (preoperative left ventricular assist device, adult congenital, or preoperative extracorporeal membrane oxygenation) and noncomplex transplant group (all others).

Results

Donor and recipient variables were similar. However, undersized patients were more likely to have a durable left ventricular assist device (P = .022). Although postoperative primary graft dysfunction and inotrope score were similar between groups, there was a trend toward increased need for postoperative dialysis with undersized hearts (P = .056). Overall, 30-day (P = .012) and 1-year survival (P = .002) was significantly worse in the undersized group compared with the matched or oversized groups. However, subset analysis showed these differences only remained among the complex transplant recipients (P = .013) but not the noncomplex transplant recipients (P = .428). Median mixed venous oxygen saturations at serial time points were maintained between 65% and 70% in all heart size groups, with cardiac indices between 2.4 and 2.8 L/min/m².

Conclusions

Small PHM ratio hearts are associated with increased 1-year mortality, driven by complex transplant operations. Recipients who received undersized PHM ratio hearts from noncomplex transplant operations had a similar hemodynamic profile and survival as those who received matched and oversized hearts. Small PHM ratio hearts may be selectively safe for transplantation.

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心脏移植供体心脏过小的安全性和后期血流动力学。

背景：预测心脏质量比（PHMr）已成为心脏移植供体-受体尺寸匹配的标准方法。虽然小型PHMr心脏的使用与一年死亡率增加有关，但潜在的机制和死亡率的时间范围仍不确定。方法：对离体心脏移植受者（2019年1月- 2022年7月）进行单机构分析（N=334）。患者按PHMr分层：undersize (1.15) （n=53）。PHMr组的生存率进一步分层：复杂移植组（术前LVAD，成人先天性或术前ECMO）和非复杂移植组（所有其他）。结果：供体和受体变量相似。然而，较小的患者更有可能有持久的LVAD （P=0.022）。虽然术后PGD和肌力评分组间相似，但小心脏术后透析需求有增加的趋势（P=0.056）。总体而言，与匹配组或超大组相比，小尺寸组的30天（P=0.012）和1年生存率（P=0.002）明显较差。然而，在亚群分析中，这些差异仅在复杂移植受者中存在（P=0.013），而在非复杂移植受者中不存在（P=0.428）。所有心脏大小组连续时间点混合静脉氧饱和度中位数维持在65-70%之间，心脏指数在2.4-2.8 LPM/m2之间。结论：由于复杂的移植手术，小的PHMr心脏与一年死亡率增加相关。接受非复杂移植手术的小尺寸PHMr心脏的受者与接受匹配和大尺寸心脏的受者具有相似的血液动力学特征和生存率。小的PHMr心脏移植可能是选择性安全的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Annals of Thoracic Surgery 医学-呼吸系统

CiteScore

6.40

自引率

13.00%

发文量

1235

审稿时长

42 days

期刊介绍： The mission of The Annals of Thoracic Surgery is to promote scholarship in cardiothoracic surgery patient care, clinical practice, research, education, and policy. As the official journal of two of the largest American associations in its specialty, this leading monthly enjoys outstanding editorial leadership and maintains rigorous selection standards. The Annals of Thoracic Surgery features: • Full-length original articles on clinical advances, current surgical methods, and controversial topics and techniques • New Technology articles • Case reports • "How-to-do-it" features • Reviews of current literature • Supplements on symposia • Commentary pieces and correspondence • CME • Online-only case reports, "how-to-do-its", and images in cardiothoracic surgery. An authoritative, clinically oriented, comprehensive resource, The Annals of Thoracic Surgery is committed to providing a place for all thoracic surgeons to relate experiences which will help improve patient care.