R A Quintana-Quezada1, I Rajapreyar2, A Postalian-Yrausquin2, Y C Yeh2, S Choi3, B Akkanti4, A Sieg5, P Weeks5, M Patel2, J Patel2, S Nathan2, B Kar2, P Loyalka2, I Gregoric2. 1. Center for Advanced Heart Failure, University of Texas Health Science Center at Houston/Memorial Hermann Hospital, Texas Medical Center, Houston, Texas. Electronic address: Raymundo.A.Quintanaquezada@uth.tmc.edu. 2. Center for Advanced Heart Failure, University of Texas Health Science Center at Houston/Memorial Hermann Hospital, Texas Medical Center, Houston, Texas. 3. Division of Clinical and Translational Sciences, Department of Internal Medicine, University of Texas Medical School at Houston, Houston, Texas. 4. Division of Critical Care, Pulmonary and Sleep, University of Texas Medical School at Houston, Houston, Texas. 5. Department of Pharmacy, Memorial Hermann - Texas Medical Center, Houston, Texas.
Abstract
BACKGROUND: Primary graft dysfunction (PGD) is a frequent complication after cardiac transplantation and remains one of the leading causes of mortality in these patients. The objective of this case-control study is to identify donor and surgical procedure's factors associated with PGD, and further guide possible strategies to prevent PGD. METHODS: Retrospective analysis of the medical records of patients who underwent cardiac transplantation at Memorial Hermann Hospital at Texas Medical Center between October 2012 and February 2015. RESULTS: The study population included 99 patients, of which 18 developed PGD. Univariate analysis of donor characteristics revealed opioid use (P = .049) and death owing to anoxia (P = .021) were associated with PGD. The recipient/donor blood type match AB/A was significantly associated with PGD (P = .031). Time from brain death to aortic cross clamp (TBDACC) of ≥3 and ≥5 days were also found to be associated with PGD (P = .0011 and .0003, respectively). Multivariate analysis confirmed that patients with a time from brain death to aortic cross clamp ≥3 and ≥5 days had lesser odds of developing PGD (odds ratio, 0.098 [P = .0026] and OR, 0.092 [P = .0017], respectively]. CONCLUSIONS: Our study showed that a longer time from brain death to aortic cross clamp was associated with lower odds of developing PGD. Therefore, postponing heart procurement for a few days after brain death seems to be beneficial in preventing PGD.
BACKGROUND:Primary graft dysfunction (PGD) is a frequent complication after cardiac transplantation and remains one of the leading causes of mortality in these patients. The objective of this case-control study is to identify donor and surgical procedure's factors associated with PGD, and further guide possible strategies to prevent PGD. METHODS: Retrospective analysis of the medical records of patients who underwent cardiac transplantation at Memorial Hermann Hospital at Texas Medical Center between October 2012 and February 2015. RESULTS: The study population included 99 patients, of which 18 developed PGD. Univariate analysis of donor characteristics revealed opioid use (P = .049) and death owing to anoxia (P = .021) were associated with PGD. The recipient/donor blood type match AB/A was significantly associated with PGD (P = .031). Time from brain death to aortic cross clamp (TBDACC) of ≥3 and ≥5 days were also found to be associated with PGD (P = .0011 and .0003, respectively). Multivariate analysis confirmed that patients with a time from brain death to aortic cross clamp ≥3 and ≥5 days had lesser odds of developing PGD (odds ratio, 0.098 [P = .0026] and OR, 0.092 [P = .0017], respectively]. CONCLUSIONS: Our study showed that a longer time from brain death to aortic cross clamp was associated with lower odds of developing PGD. Therefore, postponing heart procurement for a few days after brain death seems to be beneficial in preventing PGD.
Authors: Katalin Martits-Chalangari; Omar Hernandez; Aayla K Jamil; Huanying Qin; Joost Felius; Samuel Jacob; Brian Lima; Aldo Rafael; Gonzalo V Gonzalez-Stawinski; Melody J Sherwood; Shelley A Hall Journal: Proc (Bayl Univ Med Cent) Date: 2018-10-18