CLINICAL-TRIAL OF RETROGRADE WARM BLOOD REPERFUSION VERSUS STANDARD COLD TOPICAL IRRIGATION OF TRANSPLANTED HEARTS

Background. A prospective, randomized clinical study involving 34 pati ents undergoing heart transplantation compared myocardial preservation of donor hearts maintained with continuous reperfusion with retrograd e warm blood cardioplegia during surgical implantation versus the stan dard cold topical irrigation. Methods. Hearts in both groups were arre sted with a standard crystalloid solution and maintained in a cold sal ine solution during transportation. In the retrograde group, cardiople gia was administered through a catheter in the coronary sinus during s urgical implantation. An average of 471 +/- 30 mL of hyperkalemic crys talloid solution diluted 1:4 in warm blood from the oxygenator was inf used. In the standard group, the heart was kept cold by topical irriga tion of cold saline solution and was reperfused only when the ascendin g aorta clamped.Results. Preoperative characteristics of donors and re cipients were similar in the two cohorts. Ischemic time averaged 139 /- 12 minutes in the retrograde group compared with 130 +/- 11 minutes in the standard group (p = 0.57). Cardiopulmonary bypass time average d 89 +/- 4 minutes in the retrograde group and 110 +/- 12 minutes in t he standard group (p = 0.12). Defibrillation at reperfusion was perfor med in 4 patients (4/17, 24%) in the retrograde group and 12 patients (12/18, 67%) in the standard group (p = 0.01). There were no deaths in the retrograde group (0/17), whereas in the standard group, 3 patient s (3/17) died of early graft failure (p = 0.11). Four early graft fail ures occurred in the standard group (p = 0.06). Two patients (2/17, 12 %) were weaned from bypass with ventricular assist devices in the stan dard group. The number of subendocardial necrotic cells in the first t wo weekly endomyocardial biopsy specimens averaged 2.7 +/- 0.8 cells/m m(2) in the retrograde group and 5.9 +/- 2.4 cells/mm(2) in the standa rd group (p = 0.12). Conclusions. Retrograde warm blood reperfusion ap pears to improve the initial recovery of transplanted hearts. The tech nique is easy to use and may be a useful approach to graft protection during surgical implantation.