title: The Use of Hypothermic Circulatory Arrest During Heart Transplantation Does Not Worsen Posttransplant Survival.
abstract: BACKGROUND
  Hypothermic circulatory arrest (HCA) has been used as an adjunct to cardiopulmonary bypass for decades, both electively and emergently, to facilitate a bloodless operative field while maintaining cerebral protection. The aim of this study is to determine the impact of HCA during heart transplantation on posttransplant outcomes.
  
  
  METHODS
  All adult patients undergoing orthotopic heart transplantation at our institution between 2000 and 2012 were retrospectively reviewed. Patients were stratified based on need for HCA during surgery; patients who required HCA (HCA group, n = 25), and patients who did not (no-HCA group, n = 903). The primary outcomes of interest were 30-day and 1-year mortality and postoperative complication rate.
  
  
  RESULTS
  Indications for HCA included control of significant hemorrhage (n = 9), need for distal aortic procedures (n = 9), or as an aid in difficult mediastinal dissection (n = 7). Mean duration of HCA was 22 ± 18 minutes at a mean temperature of 24.5° ± 5.5°C. Significantly more patients in the HCA group underwent transplant for congenital heart disease (16.0% HCA versus 2.8% no-HCA, p = 0.006), and patients in the HCA group had undergone more prior sternotomies (HCA 1 [interquartile range: 1 to 2] versus no-HCA 1 [interquartile range: 0 to 1], p < 0.001]. There was no statistical difference in 30-day mortality (8.0% HCA versus 4.2% no-HCA, p = 0.29) or 1-year mortality (8.0% HCA versus 12.3% no-HCA, p = 0.76). The HCA group had higher rates of reoperation for mediastinal bleeding and postoperative respiratory failure.
  
  
  CONCLUSIONS
  The need for HCA during heart transplantation is rare but, when required, it is frequently a life-saving adjunct to cardiopulmonary bypass. However, patients who require HCA have higher rates of postoperative complications. Risk factors for needing HCA during transplantation include congenital heart disease and more than one prior sternotomies.
authors.affiliation: Division of Cardiothoracic Surgery, Columbia University College of Physicians and Surgeons, New York-Presbyterian Hospital, New York, New York.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Sorabella
authors.affiliation: Division of Cardiothoracic Surgery, Columbia University College of Physicians and Surgeons, New York-Presbyterian Hospital, New York, New York.
authors.forename: Laura
authors.initials: L
authors.lastname: Guglielmetti
authors.affiliation: Division of Cardiothoracic Surgery, Columbia University College of Physicians and Surgeons, New York-Presbyterian Hospital, New York, New York.
authors.forename: Amanda
authors.initials: A
authors.lastname: Bader
authors.affiliation: Division of Cardiothoracic Surgery, Columbia University College of Physicians and Surgeons, New York-Presbyterian Hospital, New York, New York.
authors.forename: Andres
authors.initials: A
authors.lastname: Gomez
authors.affiliation: Division of Cardiothoracic Surgery, Columbia University College of Physicians and Surgeons, New York-Presbyterian Hospital, New York, New York.
authors.forename: Koji
authors.initials: K
authors.lastname: Takeda
authors.affiliation: Division of Cardiothoracic Surgery, Columbia University College of Physicians and Surgeons, New York-Presbyterian Hospital, New York, New York.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Chai
authors.affiliation: Division of Cardiothoracic Surgery, Columbia University College of Physicians and Surgeons, New York-Presbyterian Hospital, New York, New York.
authors.forename: Hiroo
authors.initials: H
authors.lastname: Takayama
authors.affiliation: Division of Cardiothoracic Surgery, Columbia University College of Physicians and Surgeons, New York-Presbyterian Hospital, New York, New York.
authors.forename: Emile A
authors.initials: EA
authors.lastname: Bacha
authors.affiliation: Division of Cardiothoracic Surgery, Columbia University College of Physicians and Surgeons, New York-Presbyterian Hospital, New York, New York.
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Naka
authors.affiliation: Division of Cardiothoracic Surgery, Columbia University College of Physicians and Surgeons, New York-Presbyterian Hospital, New York, New York. Electronic address: ig2006@cumc.columbia.edu.
authors.forename: Isaac
authors.initials: I
authors.lastname: George
mesh_terms: D000328:Adult; D002315:Cardiopulmonary Bypass / Q000379:methods; D002423:Cause of Death; D050792:Circulatory Arrest, Deep Hypothermia Induced / Q000009:adverse effects / Q000379:methods / Q000401:mortality*; D015331:Cohort Studies; D016208:Databases, Factual; D017558:Elective Surgical Procedures / Q000379:methods / Q000401:mortality; D004638:Emergency Treatment / Q000379:methods / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D016027:Heart Transplantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D015996:Survival Rate; D014019:Tissue Donors; D016896:Treatment Outcome