VALUE OF POSTOPERATIVE ASSESSMENT OF CARDIAC ALLOGRAFT FUNCTION BY TRANSESOPHAGEAL ECHOCARDIOGRAPHY

Heart transplantation now provides an acceptable therapy for patients with severe end-stage heart disease. Although patient outcome has sign ificantly improved both early and late after heart transplantation, ea rly morbidity and mortality continues to affect overall survival and m ay be unpredictable. In an attempt to identify factors that may assist in predicting early outcome after orthotopic heart transplantation, w e assessed allograft function in 16 patients in the immediate postoper ative period, 30 minutes after weaning from cardiopulmonary bypass by measuring the fractional shortening of the left ventricle with transes ophageal echocardiography. In addition, standard hemodynamic indexes o f allograft function (arterial blood pressure, pulmonary capillary wed ge pressure, mean pulmonary artery pressure, and cardiac output) were obtained at this early time point. Early outcome was assessed by the d uration and peak dose of inotrope support required after transplantati on, requirement for mechanical support, and the duration of stay in th e intensive care unit. Left ventricular fractional shortening 30 minut es after cardiopulmonary bypass was significantly lower in those patie nts requiring inotropic support (28.4% +/- 4.6% versus 43.7% +/- 3.5%, p < 0.05), whereas hemodynamic variables failed to distinguish these groups. In those patients requiring inotropes, there was a significant negative correlation of fractional shortening with the peak dose (r = -0.87, p < 0.01) and the duration of inotropic support (r = -0.62, p < 0.05). The total ischemic time of the allograft (206 +/- 22 minutes, range 77 to 359) did not correlate with the subsequent fractional sho rtening, but patients requiring inotrope support after the operation h ad significantly longer ischemic times (259 +/- 22 versus 138 +/- 22 m inutes, p < 0.01). During the early postoperative phase, two patients with low fractional shortening required intraaortic balloon pump inser tion (fractional shortening 7.3% and 18.7%). We conclude that perioper ative assessment of allograft function by transesophageal echocardiogr aphy after orthotopic heart transplantation may provide useful indexes for predicting early outcome after heart transplantation, particularl y in patients with longer allograft ischemic times.