TRANSESOPHAGEAL ECHOCARDIOGRAPHIC ASSESSMENT OF LEFT-VENTRICULAR FUNCTION IN BRAIN-DEAD PATIENTS - ARE MARGINALLY ACCEPTABLE HEARTS SUITABLE FOR TRANSPLANTATION

Background: The brain-dead donor supply has become one of the criteria limiting the performance of heart transplantation. Conventional scree ning criteria are too limiting and exclude suitable heart donors. Echo cardiography is now widely available and is a reliable tool to assess left ventricular dysfunction in brain-dead donors. Yet few data are av ailable on the degree of left ventricular dysfunction where a transpla ntation is possible. Methods: Fifty five potential brain dead heart do nors (age 38 +/- 11 years) were prospectively evaluated by transesopha geal echocardiography (TEE) before harvesting. Fractional area change (FAG) was used to assess left ventricular function in potential brain- dead donors. Transplanted hearts were evaluated on the fifth postopera tive day. The transplantation was considered a success if the recipien t was alive, not retransplanted, without an assistance device or an ep inephrine infusion of more than 1 mg/h and showed an ejection fraction above 40%. Results: Of the 55 potential heart donors, 20 exhibited an FAC of less than 50%. Forty hearts were harvested, 36 of which were s uccessfully transplanted. Nine patients had an FAC below 50% (group H2 ) and 27 had an FAC over 50% (group H1). Four patients died: 2 from he morrhage (FAG > 50% in donors); 1 from right and one from left ventric ular dysfunction (FAG > 50% in donors). The FAC increased significantl y from 51 +/- 15% to 57 +/- 11% in 18 hearts that underwent TEE in don ors and afterwards in recipients. Overall actuarial survival was 86.2% versus 64.6% at 1 and 2 years in group H1 and group H2, respectively (P = NS). Conclusion: TEE is useful to assess left ventricular functio n in potential brain-dead donors. An FAC less than 50% is present in 3 6% of potential heart donors. Because left ventricular dysfunction is often reversible shortly after transplantation, an FAC below 50% may n ot necessarily preclude the use of hearts for transplantation. Copyrig ht (C) 1996 by W.B. Saunders Company