title: Supplemental Cardioplegia Immediately before Graft Implantation may Improve Early Post-Transplantation Outcome.
abstract: BACKGROUND
  Preservation of cardiac grafts for transplantation is not standardized and most centers use a single administration of crystalloid solution at the time of harvesting. We investigated possible benefits of an additional dose of cardioplegia dispensed immediately before implantation.
  
  
  METHODS
  Consecutive adult cardiac transplantations (2005-2012) were reviewed. Hearts were harvested following a standard protocol (Celsior 2L, 4-8°C). In 2008, 100 ml crystalloid cardioplegic solution was added and administered immediately before implantation. Univariate and logistic regression analyses were used to investigate risk factors for post-operative graft failure and mid-term outcome.
  
  
  RESULTS
  A total of 81 patients, 44 standard ("Cardio(-)") vs. 37 with additional cardioplegia ("Cardio(+)") were analyzed. Recipients and donors were comparable in both groups. Cardio(+) patients demonstrated a reduced need for defibrillation (24 vs. 48%, p = 0.03), post-operative ratio of CK-MB/CK (10.1 ± 3.9 vs. 13.3 ± 4.2%, p = 0.001), intubation time (2.0 ± 1.6 vs. 7.2 ± 11.5 days, p = 0.05), and ICU stay (3.9 ± 2.1 vs. 8.5 ± 7.8 days, p = 0.001). Actuarial survival was reduced when graft ischemic time was >180 min in Cardio(-) but not in Cardio(+) patients (p = 0.033). Organ ischemic time >180 min (OR: 5.48, CI: 1.08-27.75), donor female gender (OR: 5.84, CI: 1.13-33.01), and recipient/donor age >60 (OR: 6.33, CI: 0.86-46.75), but not the additional cardioplegia or the observation period appeared independent predictors of post-operative acute graft failure.
  
  
  CONCLUSIONS
  An additional dose of cardioplegia administered immediately before implantation may be a simple way to improve early and late outcome of cardiac transplantation, especially in situations of prolonged graft ischemia. A large, ideally multicentric, randomized study is desirable to verify this preliminary observation.
authors.affiliation: Clinic for Cardiovascular Surgery, Bern University Hospital (Inselspital), University of Bern , Bern , Switzerland.
authors.forename: Hendrik T
authors.initials: HT
authors.lastname: Tevaearai Stahel
authors.affiliation: Clinic for Cardiovascular Surgery, Bern University Hospital (Inselspital), University of Bern , Bern , Switzerland.
authors.forename: Darja
authors.initials: D
authors.lastname: Unger
authors.affiliation: Clinic for Cardiovascular Surgery, Bern University Hospital (Inselspital), University of Bern , Bern , Switzerland.
authors.forename: Juerg
authors.initials: J
authors.lastname: Schmidli
authors.affiliation: Clinic for Cardiovascular Surgery, Bern University Hospital (Inselspital), University of Bern , Bern , Switzerland.
authors.forename: Brigitta
authors.initials: B
authors.lastname: Gahl
authors.affiliation: Clinic for Cardiovascular Surgery, Bern University Hospital (Inselspital), University of Bern , Bern , Switzerland.
authors.forename: Lars
authors.initials: L
authors.lastname: Englberger
authors.affiliation: Clinic for Cardiovascular Surgery, Bern University Hospital (Inselspital), University of Bern , Bern , Switzerland.
authors.forename: Alexander
authors.initials: A
authors.lastname: Kadner
authors.affiliation: Department of Anaesthesiology and Pain Medicine, Bern University Hospital (Inselspital), University of Bern , Bern , Switzerland.
authors.forename: Balthasar
authors.initials: B
authors.lastname: Eberle
authors.affiliation: Department of Cardiology, Bern University Hospital (Inselspital), University of Bern , Bern , Switzerland.
authors.forename: Paul
authors.initials: P
authors.lastname: Mohacsi
authors.affiliation: Clinic for Cardiovascular Surgery, Bern University Hospital (Inselspital), University of Bern , Bern , Switzerland.
authors.forename: Thierry P
authors.initials: TP
authors.lastname: Carrel
keywords: cardiac surgery outcome; cardiac transplantation; cardioplegia; organ