María Jesús Valero-Masa1, Francisco González-Vílchez2, Luis Almenar-Bonet3, Maria G Crespo-Leiro4, Nicolás Manito-Lorite5, Jose Manuel Sobrino-Márquez6, Manuel Gómez-Bueno7, Juan F Delgado-Jiménez8, Félix Pérez-Villa9, Vicens Brossa Loidi10, José María Arizón-El Prado11, Beatriz Díaz Molina12, Luis de la Fuente-Galán13, Ana Portoles Ocampo14, Iris P Garrido Bravo15, Gregorio Rábago-Juan Aracil16, Manuel Martínez-Sellés17. 1. Cardiology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid. Spain. 2. Cardiology Department, Hospital Universitario Marques de Valdecilla, Santander, Spain. 3. Cardiology Department, Hospital Universitarii i Politècnic La Fe, Valencia, Spain. 4. Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid. Spain; Cardiology Department, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain. 5. Cardiology Department, Hospital Universitario de Bellvitge. L'Hospitalet del Llobregat, Barcelona, Spain. 6. Cardiology Department, Hospital Universitario Virgen del Rocío, Sevilla, Spain. 7. Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid. Spain; Cardiology Department, Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain. 8. Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid. Spain; Cardiology Department, Fundación Investigación Hospital Universitario 12 de Octubre, Facultad de Medicina, UCM, Madrid, Spain. 9. Cardiology Department, Hospital Clinic Universitari, Barcelona, Spain. 10. Cardiology Department, Hospital Universitari Santa Creu i Sant Pau, Barcelona, Spain. 11. Cardiology Department, Hospital Universitario Reina Sofía, Córdoba, Spain. 12. Cardiology Department, Hospital Universitario Central de Asturias, Oviedo, Spain. 13. Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid. Spain; Cardiology Department, Hospital Clínico Universitario de Valladolid, Spain. 14. Cardiology Department, Hospital Universitario Miguel Servet, Zaragoza, Spain. 15. Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid. Spain; Cardiology Department, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain. 16. Department of Cardiovascular Surgery, Clinica Universitaria de Navarra, Pamplona, Spain. 17. Cardiology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Madrid. Spain; Universidad Europea, Universidad Complutense, Madrid, Spain. Electronic address: mmselles@secardiologia.es.
Abstract
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.
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.
Authors: Paul C Tang; Xiaoting Wu; Min Zhang; Donald Likosky; Jonathan W Haft; Ienglam Lei; Ashraf Abou El Ela; Ming-Sing Si; Keith D Aaronson; Francis D Pagani Journal: J Card Surg Date: 2022-04-30 Impact factor: 1.778