Reducing the ischemic time of donor hearts will decrease morbidity and costs of cardiac transplantations.
With liberalization of donor eligibility criteria, donor hearts are being harvested from remote locations, increasing ischemic times. The aim of this study was to examine the effect of total ischemic time (TIT) on length of stay in the intensive care unit (LOS in ICU) and its economic consequences. The study population included recipients without prior mechanical support undergoing heart transplantation between 1998 and 2008 at a single institution. The mean age of the 72 recipients (56 men, 16 women) was 50.6 years (range 15-68 years) and the mean donor age was 41.5 years (range 11-61 years). The median TIT was 181.2 min (range 107-243) and median LOS in ICU was 11.5 days (range 3-107 days). There was a statistically significant linear relationship between TIT and LOS in ICU r(72)=0.317, P=0.004. Each 5 min and 38 s of TIT equated to one more day in ICU. An ischemic time >180 min was associated with higher LOS in ICU, renal failure, and a more frequent use of nitric oxide in our cohort. For longer distance harvesting, the reduction of TIT by the fastest possible transport (learjet, helicopter) would have economic advantages with regards to the high cost of treatment in ICU.
Rylski
Bartosz
B
Department of Cardiovascular Surgery, University of Freiburg, Freiburg, Germany. bartosz.rylski@uniklinik-freiburg.de
Berchtold-Herz
Michael
M
Olschewski
Manfred
M
Zeh
Wolfgang
W
Schlensak
Christian
C
Siepe
Matthias
M
Beyersdorf
Friedhelm
F
D000293:Adolescent; D000328:Adult; D000368:Aged; D050377:Cold Ischemia / Q000009:adverse effects* / Q000191:economics* / Q000401:mortality; D017046:Cost Savings; D003422:Critical Care / Q000191:economics; D016527:Drug Costs; D005260:Female; D005858:Germany; D016027:Heart Transplantation / Q000009:adverse effects* / Q000191:economics* / Q000401:mortality; D006440:Hemofiltration / Q000191:economics; D017721:Hospital Costs; D006801:Humans; D007423:Intra-Aortic Balloon Pumping / Q000191:economics; D053208:Kaplan-Meier Estimate; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D009569:Nitric Oxide / Q000008:administration & dosage / Q000191:economics; D016016:Proportional Hazards Models; D051437:Renal Insufficiency / Q000191:economics / Q000209:etiology; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014019:Tissue Donors / Q000600:supply & distribution*; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult
D009569:Nitric Oxide